You can always press Enter⏎ to continue
Male Baby Readiness Assessment
START
1
How would you describe your current state of health?
*
This field is required.
Excellent
Good
Fair
Poor
Previous
Next
Submit
Press
Enter
2
On a scale from 1-10, how much do you think your overall health affects the ability to conceive for you and your partner?
*
This field is required.
Please Select
1
2
3
4
5
6
7
8
9
10
Please Select
Please Select
1
2
3
4
5
6
7
8
9
10
Previous
Next
Submit
Press
Enter
3
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
4
Have you been diagnosed with any of the following?
*
This field is required.
Anemia
Inherited blood disorder (e.g., sickle cell, thalassemia)
None
Previous
Next
Submit
Press
Enter
5
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
6
Do you have any of the following symptoms?
*
This field is required.
Fatigue / weakness
Headache, dizziness or lightheadedness
Cold hands and feet
Pale skin
Chest pain, fast heartbeat, or shortness of breath
Brittle nails
None
Previous
Next
Submit
Press
Enter
7
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
8
Image Field
Previous
Next
Submit
Press
Enter
9
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
10
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
11
Have you been diagnosed with any of the following conditions?
*
This field is required.
Autoimmune disease (e.g. Crohn’s, rheumatoid arthritis, MS, Celiac, etc.)
Cancer
Sexually transmitted infection(s)
None
Previous
Next
Submit
Press
Enter
12
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
13
Do you experience any of the following symptoms?
*
This field is required.
Fatigue
Joint pain and swelling
Skin problems
Abdominal pain or digestive issues
Swollen glands
None
Previous
Next
Submit
Press
Enter
14
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
15
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
16
Have you been diagnosed with any of the following?
*
This field is required.
Low testosterone
Hypothyroid / thyroid disorder
None
Other
Previous
Next
Submit
Press
Enter
17
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
18
Image Field
Previous
Next
Submit
Press
Enter
19
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
20
Do you experience any of the following symptoms?
*
This field is required.
Acne
Bloating
Low libido
Migraines
Sensitivity to cold
Weight gain
Constipation
None
Previous
Next
Submit
Press
Enter
21
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
22
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
23
Have you been diagnosed with any of the following conditions?
*
This field is required.
Pre-diabetes or diabetes
Hypertension
None
Previous
Next
Submit
Press
Enter
24
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
25
Do you have any of the following symptoms?
*
This field is required.
Severe headaches
Lightheadedness / fainting
Fatigue, especially after eating
Increased thirst and/or frequent urination
None
Previous
Next
Submit
Press
Enter
26
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
27
Image Field
Previous
Next
Submit
Press
Enter
28
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
29
Have you been diagnosed with any of the following?
*
This field is required.
Vitamin D deficiency
B Vitamin deficiency (e.g., folate, B12)
None
Previous
Next
Submit
Press
Enter
30
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
31
Do you have any of the following symptoms?
*
This field is required.
Fatigue
Headaches
Pale or yellow skin
Poor memory
Burning / pins-and-needles sensation in hands and feet
Dry skin
Mood swings or depression
Pain / inflammation of the mouth and tongue
None
Previous
Next
Submit
Press
Enter
32
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
33
How often do you have the following foods?
*
This field is required.
Never
Occasionally
Frequently
Daily
Coffee
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Packaged beverages (e.g. juice, soda, energy drinks)
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Packaged snacks, including sweet (e.g. cakes, cookies, candies) and savory (e.g. chips, pretzels)
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Fast food
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Alcohol
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Sugar in any processed form (e.g. agave, brown rice syrup, candy, fruit juice concentrate, high fructose corn syrup, sugar)
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Leafy green vegetables
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Coffee
Packaged beverages (e.g. juice, soda, energy drinks)
Packaged snacks, including sweet (e.g. cakes, cookies, candies) and savory (e.g. chips, pretzels)
Fast food
Alcohol
Sugar in any processed form (e.g. agave, brown rice syrup, candy, fruit juice concentrate, high fructose corn syrup, sugar)
Leafy green vegetables
Never
Row 0, Column 0
Occasionally
Row 0, Column 1
Frequently
Row 0, Column 2
Daily
Row 0, Column 3
Never
Row 1, Column 0
Occasionally
Row 1, Column 1
Frequently
Row 1, Column 2
Daily
Row 1, Column 3
Never
Row 2, Column 0
Occasionally
Row 2, Column 1
Frequently
Row 2, Column 2
Daily
Row 2, Column 3
Never
Row 3, Column 0
Occasionally
Row 3, Column 1
Frequently
Row 3, Column 2
Daily
Row 3, Column 3
Never
Row 4, Column 0
Occasionally
Row 4, Column 1
Frequently
Row 4, Column 2
Daily
Row 4, Column 3
Never
Row 5, Column 0
Occasionally
Row 5, Column 1
Frequently
Row 5, Column 2
Daily
Row 5, Column 3
Never
Row 6, Column 0
Occasionally
Row 6, Column 1
Frequently
Row 6, Column 2
Daily
Row 6, Column 3
1
of 7
Previous
Next
Submit
Press
Enter
34
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
35
Are you currently taking a multivitamin?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
36
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
37
Do you follow a vegan or vegetarian diet?
*
This field is required.
YES
NO
Previous
Next
Submit
Press
Enter
38
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
39
Image Field
Previous
Next
Submit
Press
Enter
40
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
41
BMI Calculator
*
This field is required.
Please enter your weight and height.
Previous
Next
Submit
Press
Enter
42
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
43
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
44
Have you been diagnosed with any of the following conditions?
*
This field is required.
Depression
Anxiety
None
Previous
Next
Submit
Press
Enter
45
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
46
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
47
How old are you?
*
This field is required.
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45 - 59
60+
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45 - 59
60+
Previous
Next
Submit
Press
Enter
48
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
49
How many prescription medications do you take?
*
This field is required.
0
1
2
3
4+
0
1
2
3
4+
Previous
Next
Submit
Press
Enter
50
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
51
Which best describes your current estimate of when you and your partner would like to get pregnant?
*
This field is required.
Currently trying (naturally)
Currently trying (assisted reproductive technology - IUI or IVF)
In the next 3 months
In the next 6 months
In the next 1 year
In the next couple of years
Further in the future, not sure when
Not interested in getting pregnant, just curious
Currently trying (naturally)
Currently trying (assisted reproductive technology - IUI or IVF)
In the next 3 months
In the next 6 months
In the next 1 year
In the next couple of years
Further in the future, not sure when
Not interested in getting pregnant, just curious
Previous
Next
Submit
Press
Enter
52
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
53
Image Field
Previous
Next
Submit
Press
Enter
54
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
55
On a scale from 1-10, how anxious are you about you and your partner's ability to conceive when you’re ready to (1 - not at all, 10 - extremely anxious)
*
This field is required.
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Previous
Next
Submit
Press
Enter
56
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
57
First Name
*
This field is required.
Previous
Next
Submit
Press
Enter
58
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
59
Email
*
This field is required.
By providing your email, you are opting in to view your baby-readiness zone and to receive emails from Poplin
example@example.com
Previous
Next
Submit
Press
Enter
60
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
61
Score Calculation
Previous
Next
Submit
Press
Enter
62
'; var analyticsAutoLink = ''; (function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o), m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m) })(window,document,'script','https://www.google-analytics.com/analytics.js','ga'); ga('create', ' ', 'auto', {'allowLinker': true}); ga('send', 'pageview'); if(window.analyticsAutoLink && analyticsAutoLink != '
') {analyticsAutoLink = analyticsAutoLink.replace(/ /g, '').split(/[,\n]/g);ga('require', 'linker');ga('linker:autoLink', analyticsAutoLink);}
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
62
See All
Go Back
Submit