Please fill out this brief questionnaire. At the end of the questionnaire, you'll have the option to schedule a call with Tafiq on the date and time of your choosing.
Click the button below to start.
Question 1 of 13
Are you currently experiencing any of the 3 stages of menopause: Peri-Menopause, Menopause, or Post-Menopause?
Yes
No
Not sure
Question 2 of 13
If yes, are you on Hormone Replacement Therapy (HRT) or taking any other medication for menopause?
N/A
Question 3 of 13
What are the TOP 3 most pressing health and wellness CHALLENGES (aside from weight loss) you need help with right now the most?
Question 4 of 13
Combinations of symptoms are what trigger most negative health and wellness issues. Please check all the symptoms you experience on a regular basis:
Trouble falling asleep
Trouble waking up in the morning
Brain fog/lack of mental clarity
Lack of mental clarity
Hot flashes/night sweats
Low libido
Hair loss or thinning
Question 5 of 13
With your job, are you primarily...
Sedentary
Active
I do not work and I'm pretty sedentary
I do not work but I'm pretty active
Question 6 of 13
Are you married or have a significant other?
Question 7 of 13
Will your spouse or significant other be supportive of you working with a coach to reach your health and fitness goals?
Question 8 of 13
On a scale from 1-10, 10 being "I'M READY LET'S DO THIS". How ready are you to commit to transforming your health?
Question 9 of 13
If you are not at a 10, what is stopping you from being at a 10?
Question 10 of 13
Have you invested in your health and wellness in the past?
Question 11 of 13
If yes, what did you like AND dislike about the experience (please explain in detail)?
Question 12 of 13
How did you hear about me and my program?
Question 13 of 13
Is there anything you'd like to add?