Mountain Mama
Wellness Inc.

Created from a deep desire to offer women a safe, supportive space to heal — without pressure or feeling overwhelmed. With 20+ years in the wellness space, I support women through:

Hormone health
Weight management
Supplementation
Gut health
Feeling like themselves again

My journey has taken me from traditional healthcare to my office in the mountains.

No waiting room. No worries. Just healing—your way, outdoors in nature or virtually through telehealth.

Kristy Cirami NDTR

Hormone Health Registered Nutritionist
Certified in Weight Management, Supplementation & Gut Health

Assessment Received!

Thank you for sharing. Kristy will be in touch with you soon to discuss your wellness journey.

Contact Information

Full Name *

Age

Email Address *

Phone Number

Preferred Way to be Contacted

Energy

How would you describe your energy throughout the day?

Do you experience an afternoon energy crash?

Do you rely on caffeine to get through the day?

Sleep

How many hours of sleep do you typically get each night?

Do you fall asleep easily?

Do you stay asleep through the night?

Do you wake up feeling rested?

Digestion

How would you describe your digestion?

Do you experience any of the following? Check all that apply

Bloating Gas Constipation Diarrhea Heartburn / Reflux None of the above

Hormone History

When was your last menstrual period?

Have you noticed changes in your cycle, flow, or symptoms?

Have you ever used hormone therapy or birth control?

Have you had hormone testing done?

Your Goals

What is your biggest hormone-related concern right now?

What would you most like to improve about your health?

What would feeling like your best self look like?

Your information is confidential and will only be reviewed by Kristy.

Mountain MamaWellness Inc.

Your Health Assessment