Test | BeBalanced Centers

Are imbalanced hormones holding you back from reaching your goal weight and living your best life?

If you’re having a hard time losing weight (despite diet and exercise), dealing with anxiety, mood swings, relentless fatigue, or sleepless nights – it’s time to investigate the root cause!

Take the quiz to uncover your hormone imbalance level and uncover key factors that could be holding you back.

Let’s get started!

TELL US ABOUT YOU

Male or Female*

I am a Male

I am a Female

What is your age?*

Under 35

35-50

Over 50

Which best describes your reproductive stage?*

I menstruate monthly.

I’ve been experiencing irregular cycles (sometime skipping a month or more).

I haven’t had a period for over a year.

What is your weight-related goal?*

I would like to lose less than 20 lbs.

I would like to lose 20-50 lbs.

I have more than 50 lbs. to lose.

Weight Loss is not important to me; I just want to feel better and be healthier.

WHAT ARE YOUR WEIGHT LOSS GOALS?

What have you done in the past to lose (or try to lose) weight? (Select all that apply)*

Healthy eating and exercise

Counting calories

Weight loss programs such as Weight Watchers, Nutrisystem, Noom, etc.

Medically assisted weight loss

Specific dietary protocols such as keto, paleo, Whole30, etc.

Intermittent fasting

I have NEVER tried to lose weight

Of the methods you have used to lose (or try to lose weight), how successful were you?*

Very successful and I have kept the weight off

I lost weight but gained it back

I was not able to lose weight or was disappointed with my results

No matter what you eat (or don’t eat), or how much you exercise, if your hormones are out of balance, losing weight can be a struggle.

How long have you been trying to lose weight?*

Losing weight has been a life-long battle

The past few years, nothing has been working

About a year

Less than a year

This is the first time I’ve thought about it.

According to a recent client survey...

The average weight loss during the first 30 days of our program was 18.01 pounds.

What do you feel has been a hindrance to your weight loss success in the past? (Select all that apply)*

Overwhelming cravings

Lack of motivation/drive

Unsustainable program(s)

Little to no support

I gave up because I wasn’t seeing results

At BeBalanced we offer guided support and tools to help you address key issues that could be holding you back from reaching and maintaining your desired weight.

What is motivating you to lose weight now? (Select all that apply)*

My overall health

Improvement in my quality of life

I want to fit back into my favorite clothes again

I want to feel better in my own skin

Imagine yourself at your goal weight… What will that feel like for you? (Select all that apply)*

I will feel so much better about myself because I will have more confidence.

I will have more energy.

I will be in the clothing size I want to be in.

My health will be so much better.

My relationship with my spouse/significant other will improve.

I will be able to do things more comfortably.

I will bring a healthier lifestyle to my family.

At BeBalanced, we know that losing weight is about SO much more than a number on the scale. Often, it means “getting you back,” and we want to help you do just that.

When you reach your weight loss goal, what is the first thing you will do?*

Although PMS and other symptoms related to your period are common, they are NOT normal. They are signals that something is out off balance.

Hormones impact nearly every function in the body. So, if even one hormone is out balance, it can cause a cascade of issues resulting in a host of unpleasant symptoms.

Regarding your gut/digestive health, do you experience any of the following symptoms on a regular basis? (Select all that apply)*

Bloating after meals

Diarrhea

Constipation

Strong sugar cravings

Food allergies and sensitivities

Seasonal allergies

Joint pain and fibromyalgia

Skin issues like rosacea and eczema

Autoimmune diseases

Problems and imbalances in our gut can cause more than just stomach pain, gas, bloating, or diarrhea. They can be the root cause of many chronic health problems and can contribute to imbalanced hormones.

WHAT IS YOUR STRESS LEVEL?

Please rate your average stress level choosing one of the options below.*

I have no stress in my life.

My life can be stressful at times.

My life is stressful a lot of the time.

My life is constantly stressful.

Are any of the following a part of your regular routine (Select all that apply).*

I eat processed foods more than 1 time/week.

I do intense cardio (like running) for more than 20 minutes at a time.

I use plastic containers to heat my food.

My daily environment has artificial lighting.

I drink from plastic water bottles often.

I get less than 7 hours of sleep at night.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.

Leading up to, or during your period, do you experience any of the following hormone-related symptoms? (Select all that apply)*

Menstrual cramps

Irritability

Mood swings

Fluid retention/bloating

Heavy bleeding

Breast tenderness

Headaches/migraines

Feeling anxious or depressed

Low energy

Although PMS and other symptoms related to your period are common, they are NOT normal. They are signals that something is out off balance.

Hormones impact nearly every function in the body. So, if even one hormone is out balance, it can cause a cascade of issues resulting in a host of unpleasant symptoms.

Regarding your gut/digestive health, do you experience any of the following symptoms on a regular basis? (Select all that apply)*

Bloating after meals

Diarrhea

Constipation

Strong sugar cravings

Food allergies and sensitivities

Seasonal allergies

Joint pain and fibromyalgia

Skin issues like rosacea and eczema

Autoimmune diseases

Problems and imbalances in our gut can cause more than just stomach pain, gas, bloating, or diarrhea. They can be the root cause of many chronic health problems, and can contribute to imbalanced hormones.

WHAT IS YOUR STRESS LEVEL?

Please rate your average stress level choosing one of the options below.*

I have no stress in my life.

My life can be stressful at times.

My life is stressful a lot of the time.

My life is constantly stressful.

Are any of the following a part of your regular routine (Select all that apply).*

I eat processed foods more than 1 time/week.

I do intense cardio (like running) for more than 20 minutes at a time.

I use plastic containers to heat my food.

My daily environment has artificial lighting.

I drink from plastic water bottles often.

I get less than 7 hours of sleep at night.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.

Regarding your gut/digestive health, do you experience any of the following symptoms on a regular basis? (Select all that apply)*

Bloating after meals

Diarrhea

Constipation

Strong sugar cravings

Food allergies and sensitivities

Seasonal allergies

Joint pain and fibromyalgia

Skin issues like rosacea and eczema

Autoimmune diseases

Problems and imbalances in our gut can cause more than just stomach pain, gas, bloating, or diarrhea. They can be the root cause of many chronic health problems and can contribute to imbalanced hormones.

WHAT IS YOUR STRESS LEVEL?

Please rate your average stress level choosing one of the options below.*

I have no stress in my life.

My life can be stressful at times.

My life is stressful a lot of the time.

My life is constantly stressful.

Are any of the following a part of your regular routine (Select all that apply).*

I eat processed foods more than 1 time/week.

I do intense cardio (like running) for more than 20 minutes at a time.

I use plastic containers to heat my food.

My daily environment has artificial lighting.

I drink from plastic water bottles often.

I get less than 7 hours of sleep at night.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.

Hormones impact nearly every function in the body. So, if even one hormone is out balance, it can cause a cascade of issues resulting in a host of unpleasant symptoms.

Problems and imbalances in our gut can cause more than just stomach pain, gas, bloating, or diarrhea. They can be the root cause of many chronic health problems and can contribute to imbalanced hormones.

WHAT IS YOUR STRESS LEVEL?

Please rate your average stress level choosing one of the options below.*

I have no stress in my life.

My life can be stressful at times.

My life is stressful a lot of the time.

My life is constantly stressful.

Are any of the following a part of your regular routine (Select all that apply).*

I eat processed foods more than 1 time/week.

I do intense cardio (like running) for more than 20 minutes at a time.

I use plastic containers to heat my food.

My daily environment has artificial lighting.

I drink from plastic water bottles often.

I get less than 7 hours of sleep at night.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.

Full Name*

Email*

Phone*

ZIP Code*

How did you hear about us?*

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Book a Free Consultation

Find your local BeBalanced Center

Are imbalanced hormones holding you back from reaching your goal weight and living your best life?

TELL US ABOUT YOU

WHAT ARE YOUR WEIGHT LOSS GOALS?

No matter what you eat (or don’t eat), or how much you exercise, if your hormones are out of balance, losing weight can be a struggle.

According to a recent client survey...The average weight loss during the first 30 days of our program was 18.01 pounds.

At BeBalanced we offer guided support and tools to help you address key issues that could be holding you back from reaching and maintaining your desired weight.

At BeBalanced, we know that losing weight is about SO much more than a number on the scale. Often, it means “getting you back,” and we want to help you do just that.

WHAT IS YOUR HORMONE IMBALANCE LEVEL?

Please answer the following symptom-based questions to help uncover your current hormone imbalance level.

Although PMS and other symptoms related to your period are common, they are NOT normal. They are signals that something is out off balance.

Hormones impact nearly every function in the body. So, if even one hormone is out balance, it can cause a cascade of issues resulting in a host of unpleasant symptoms.

Problems and imbalances in our gut can cause more than just stomach pain, gas, bloating, or diarrhea. They can be the root cause of many chronic health problems and can contribute to imbalanced hormones.

WHAT IS YOUR STRESS LEVEL?

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.Please take a moment to breathe deeply while we calculate your results.

Although PMS and other symptoms related to your period are common, they are NOT normal. They are signals that something is out off balance.

Hormones impact nearly every function in the body. So, if even one hormone is out balance, it can cause a cascade of issues resulting in a host of unpleasant symptoms.

Problems and imbalances in our gut can cause more than just stomach pain, gas, bloating, or diarrhea. They can be the root cause of many chronic health problems, and can contribute to imbalanced hormones.

WHAT IS YOUR STRESS LEVEL?

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance. Please take a moment to breathe deeply while we calculate your results.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance. Please take a moment to breathe deeply while we calculate your results.

Problems and imbalances in our gut can cause more than just stomach pain, gas, bloating, or diarrhea. They can be the root cause of many chronic health problems and can contribute to imbalanced hormones.

WHAT IS YOUR STRESS LEVEL?

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance. Please take a moment to breathe deeply while we calculate your results.

Hormones impact nearly every function in the body. So, if even one hormone is out balance, it can cause a cascade of issues resulting in a host of unpleasant symptoms.

Problems and imbalances in our gut can cause more than just stomach pain, gas, bloating, or diarrhea. They can be the root cause of many chronic health problems and can contribute to imbalanced hormones.

WHAT IS YOUR STRESS LEVEL?

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance. Please take a moment to breathe deeply while we calculate your results.

According to a recent client survey...

The average weight loss during the first 30 days of our program was 18.01 pounds.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.

One of the main culprits of imbalanced hormones is STRESS! And it’s not just emotional stressors that impact us. Lack of sleep and even toxins in the environment can cause stress in our bodies, throwing us out of balance.

Please take a moment to breathe deeply while we calculate your results.