Name * First Name Last Name 1. What do you currently struggle most with around food? * Staying consistent Not knowing what to eat Emotional or stress eating Low energy / hormone symptoms Finding meals that fit my culture Other 2. Which of these would help you most right now? * Simple, balanced meal ideas Nutrition accountability or check-ins Learning how to listen to my body Support for hormones / cycle health A personalized meal plan Recipes in Spanish 3. How would you describe your relationship with food? * I’m struggling a lot I’m learning and improving It’s okay but could be better I feel balanced most days I’m confident and consistent 4. What’s your top health or lifestyle goal for 2025/2026? * Example: “more energy,” “meal consistency,” “hormone balance,” “lose fat in a healthy way,” etc. 5. What language(s) do you prefer for our content? * English Spanish Both 6. Would you like to receive: * Free meal & cycle resources Updates on new classes / products Monthly wellness newsletter with meal + mindset tips Invites to our group classes & community meetups Email * Phone * (###) ### #### Anything else you would like to tell us? Thank you!
