Womb Assessment

Let’s check in with what your body is communicating.

This quick assessment tracks seven key cycle and wellness symptoms. Complete it based on how you are feeling right now.

Your name

Your email

There are no perfect answers. Choose the response that most closely reflects your experience today.

Question 1

Mood shifts

How much do mood changes affect you during your cycle?

Choose one

None0

Mild1

Moderate2

Severe3

Question 2

Flow intensity

How would you describe your menstrual flow?

Choose one

Normal0

Light1

Heavy2

Question 3

Pain

How much pain or discomfort do you experience during your cycle?

Choose one

None0

Mild1

Moderate2

Severe3

Question 4

Clotting

How much or how often do you notice blood clots during your period?

Choose one

None0

Small or occasional1

Moderate2

Large or frequent3

Question 5

Cycle duration

How long does your period typically last?

Choose one

3 to 5 days0

Less than 3 days1

6 to 7 days2

More than 7 days3

Question 6

Low energy or fatigue

Rate how drained or tired you feel.

Choose a number from 0 to 10

0 · Full energy10 · Extremely low energy

Question 7

Bloating

Rate the amount of bloating you experience.

Choose a number from 0 to 10

0 · No bloating10 · Severe bloating

Review

One last look before you submit.

Your responses will create your individual Womb Assessment record for Coach Phyllis to review.

Name

Mood shifts

Flow intensity

Pain

Clotting

Cycle duration

Low energy / fatigue

Bloating

Total symptom score 0 / 34

✓

Assessment submitted

Thank you, Queen.

Your Womb Assessment has been saved for review.

Total symptom score: / 34