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Welcome
Hi there, I invite you to fill out this brief questionnaire to see if we might be a good fit to work together.
9
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1
Name
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First Name
Last Name
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2
Email
*
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example@example.com
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3
Did you watch the brief training?
*
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YES
NO
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4
Are you interested in getting pregnant in the next 3-6 months?
*
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YES
NO
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5
What do you think your biggest challenge to getting pregnant naturally is?
*
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Age
Health diagnosis
Irregular cycle
Not sure if I’m ovulating or know when I’m fertile
egg quality
Not sure why, I've tried everything
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6
Are you currently working with a doctor, specialist, acupuncturist or anyone else?
*
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YES
NO
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7
Have you had kids previously?
*
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Not yet, I am trying for my first
Yes, I have kid(s) and I'm struggling to get pregnant again
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8
Have you ever experienced a pregnancy loss?
*
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If so, my heart goes out to you. I know how devastating that is!
YES
NO
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9
I understand that IVF treatments and other medical procedures can cost upwards of $100,000. I work with women who want to get pregnant naturally and I understand the investment starts at $2,000 USD…
*
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I understand and am ready to invest in my health now.
I am not sure yet but I have the resources to invest if this feels like a good fit.
No, I don’t have the financial resources at this time.
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