Baby-readiness Quiz (Male)

How would you describe your current state of health?* This field is required.

Excellent

Good

Fair

Poor

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.

Have you been diagnosed with any of the following?* This field is required.

Anemia

Inherited blood disorder (e.g., sickle cell, thalassemia)

None

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

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

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

Have you been diagnosed with any of the following?* This field is required.

Low testosterone

Hypothyroid / thyroid disorder

None

Other

Do you experience any of the following symptoms?* This field is required.

Acne

Bloating

Low libido

Migraines

Sensitivity to cold

Weight gain

Constipation

None

Have you been diagnosed with any of the following conditions?* This field is required.

Pre-diabetes or diabetes

Hypertension

None

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

Have you been diagnosed with any of the following?* This field is required.

Vitamin D deficiency

B Vitamin deficiency (e.g., folate, B12)

None

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

How often do you have the following foods?* This field is required.

Are you currently taking a multivitamin?* This field is required.

YESNO

Do you follow a vegan or vegetarian diet?* This field is required.

YESNO

BMI Calculator* This field is required.Please enter your weight and height.

Have you been diagnosed with any of the following conditions?* This field is required.

Depression

Anxiety

None

How old are you?* This field is required.

How many prescription medications do you take?* This field is required.

Which best describes your current estimate of when you and your partner would like to get pregnant?* This field is required.

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.

First Name* This field is required.

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

Score Calculation