Questionnaire – Dr. Jen Cisternino

Contact Us: (416) 301-3477

Home
About Me
Contact
Weight Loss
Naturopath Services
Questionnaire
Blog
Videos
Menu

Hormone Balancing

Most people who struggle with their weight have some sort of hormonal imbalance. Whether it is estrogen, progesterone, testosterone, cortisol, insulin, thyroid or adrenal hormones- each play an important role in healthy weight management. Deficiencies or excesses of each can hinder your weight loss efforts.

How do you know if you are out of balance? Take this simple quiz to see if you have adrenal or thyroid imbalances that may be contributing to your weight gain.

Full Name *

Email Address *

Phone Number *

Have you been experiencing extreme fatigue that no matter how early you go to bed or how late you wake up, it does not resolve?

Yes

Have you noticed a change in your weight, particularly increased weight gain in your abdomen and thighs?

Yes

Do you experience difficulty losing weight no matter what efforts you try, and find it rather easy to gain weight?

Yes

Do you feel as though your mood is not as "happy" as you would like it to be, and sometimes have feelings of depression?

Yes

Do you suffer from joint pain?

Yes

Have you noticed your sex drive to be less than optimal?

Yes

Do you get sick quite frequently and feel like your immune system isn't as strong as you would like it to be?

Yes

Do you experience problems with your blood pressure being too high or too low- feeling dizzy or light-headed ?

Yes

Do you crave sugar or salt?

Yes

Do you have symptoms of mental fogginess, inability to concentrate and complete tasks in a timely manner?

Yes

Do you tend to be constipated (inability to have a regular bowel movement daily)?

Yes

Have you experienced thinning of your hair and /or hair loss?

Yes

Do you always feel cold and tend to have cold hands and feet?

Yes

Do you have any difficulty swallowing or feel as if food can get stuck in your throat?

Yes

Do you experience puffiness and swelling in your face and extremities?

Yes

Please Indicate your Age

If you are human, leave this field blank.

Caring for Your Health, Naturally

Visit Dr. Jen Cisternino to receive healthy, naturopathic treatment through gentle, individual healing. Understand the root cause of your suffering.

Get Connected

Scroll to top

Hormone Balancing

Categories

Caring for Your Health, Naturally

Get Connected