Womb Wellness Assessment

A clearer picture of where your health is today.

This guided check-in helps us understand your current habits, symptoms, support needs, and health related spending before we review your next steps.

Full name

Email address

Answer based on where you are today. There are no perfect answers. Your responses help us see what deserves attention first.

Your motivation

Your 5 Whys

Start with what you want to change, then go deeper. Each answer should help uncover why this matters to you personally.

1

Why is improving your health important to you right now?

2

Why does that matter to you?

3

Why is that important on a deeper level?

4

What would change in your life if this improved?

5

What is the deepest reason this matters to you?

Daily foundations

Use a 1 to 10 scale. One means this area needs significant attention. Ten means you feel strong and consistent here.

Cycle symptom tracker

Choose the answer that best reflects your current cycle. A lower total score reflects fewer or less intense symptoms.

Current symptoms

Select every symptom that currently applies. Your selections will be highlighted inside your Hormonal Assessment for review.

Monthly spending

Estimate what you typically spend in one month. If an item does not apply, leave it at zero.

Medical spending

Estimate what you personally pay in a typical year for the health related expenses below.

Review

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

Name

Health performance score

Period symptom score

Symptoms selected

Monthly unhealthy expenses

Yearly unhealthy and medical related expenses

✓

Assessment submitted

Your assessment has been saved and organized into your individual record for review.