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LunaBridge Hormonal & Metabolic Wellbeing (LHMW) Assessment

Welcome!
Thank you for taking the time to complete the LHMW Assessment. This 8-10 minute assessment is designed to provide a snapshot of your overall wellness, including your hormonal and metabolic wellbeing, and identify areas that may benefit from further attention.
There are no right or wrong answers. Please answer each question as accurately as possible—the more accurate your responses, the more meaningful your assessment will be.

1. Privacy & Confidentiality Notice

This assessment is conducted independently by [Company Name]. Your privacy is important to us.
Confidentiality: Your individual responses, assessment scores, and personal information will remain strictly confidential. They will NOT be shared with your employer, HR, managers, or any third party without your consent. Your employer may receive only aggregated and anonymized insights that cannot identify any individual participant.
How Your Information Will Be Used: Your responses will be used only to evaluate your assessment, prepare your personalized report, contact you regarding your results (if required) and improve the wellness program in an anonymized manner.
Data Security: Your assessment is collected through Tally Forms and handled using appropriate technical and administrative safeguards to protect your information.
Voluntary Participation: Participation is entirely voluntary. You may choose not to answer any question or discontinue the assessment at any time before submitting the form.
Important Note: This assessment is a preventive wellness screening tool intended for educational purposes. It is not a medical diagnosis and should not be considered a substitute for professional medical advice, diagnosis, or treatment.

SECTION 0 — ABOUT YOU

Are you taking this assessment through your employer's corporate wellness partnership with LunaBridge?

A
B

First Name

Last Name

Age

A
B
C
D
E

Email

Mobile

Height (cm)

Weight (Kgs)

Waist (Inches)

Menstrual Status: Which best describes your current menstrual status?

A
B
C
D

Have you been diagnosed with any of the following?

Additional Health Information

SECTION 1 – ENERGY, MENTAL WELLBEING & SLEEP

1. How would you rate your overall energy levels?

A
B
C
D
E

2. How often do you experience brain fog or difficulty concentrating?

A
B
C
D
E

3. Have you noticed any change in your memory compared with a few years ago?

A
B
C
D
E

4. How well do you sleep at night?

A
B
C
D
E

5. How often do you feel stressed or overwhelmed?

A
B
C
D
E

SECTION 2 – METABOLIC & PHYSICAL WELLBEING

6. Over the last 1-2 years, have you gained weight without major changes in your diet or activity?

A
B
C
D
E

7. How well does your body recover after physical or mental exertion?

A
B
C
D
E

8. How often do you crave sweets, sugary drinks or refined carbohydrates?

A
B
C
D
E

9. After eating, how long do you usually stay full?

A
B
C
D
E

10. How physically active are you?

A
B
C
D
E

SECTION 3 – HORMONAL & EMOTIONAL WELLBEING

11. How often do you experience hot flashes, night sweats or sudden warmth?

A
B
C
D
E

12. How often do you experience mood changes, anxiety or irritability?

A
B
C
D
E

13. How would you rate your motivation and enthusiasm?

A
B
C
D
E

14. Have you noticed a change in your muscle strength or physical stamina compared with a few years ago?

A
B
C
D
E

15. Overall, how much are these symptoms affecting your daily life?

A
B
C
D
E

SECTION 4 – NUTRITION, DIGESTION & LIFESTYLE

16. How many servings of vegetables and fruits do you consume daily?

A
B
C
D
E

17. How often do you consume protein-rich foods with your meals?

A
B
C
D
E

18. How often do you eat packaged, fried or ultra-processed foods?

A
B
C
D
E

19. How often do you experience digestive issues such as bloating, acidity or constipation?

A
B
C
D
E

20. When you feel stressed, how do you usually respond?

A
B
C
D
E

SECTION 5 — YOUR PRIORITIES & SUPPORT

21. During the past four weeks, how much have health or wellbeing concerns affected your ability to work at your usual level?

22. During the past four weeks, have health or wellbeing concerns caused you to take time away from work?

23. Which areas of your health and wellbeing would you most like to focus on right now? (Select up to three)

24. What kind of support would you be most interested in?

25. What is the biggest challenge you face in looking after your health and wellbeing?

Consent

I have read and understood the Terms and Privacy Policy notice and voluntarily consent to LunaBridge Private Limited collecting and processing my responses to prepare and share my personalized wellbeing assessment.
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