Peer Advo App

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number
Please enter a valid phone number.
4
Zip code of your current place of residence:* This field is required.
5
What is your age?
6
Which of the following do you experience? (Please select all that apply.)* This field is required.
Adenomyosis
Endometriosis
Fibroids
PCOS
Other
7
Which conditions have you had an official diagnosis for? (Please select all that apply)* This field is required.
Fibroids
Adenomyosis
Endometriosis
PCOS
Other
8
Which of the following best describes your current stage of medical care?* This field is required.
Newly Diagnosed: Just beginning to explore treatment options.
Diagnosis without active follow-up: Diagnosed over a year ago but currently not pursuing treatment.
Awaiting treatment: Treatment plan established, awaiting start.
Undergoing treatment: Receiving treatments such as hormonal therapy, pain management, medication, or lifestyle intervention.
Pre-Surgery: Scheduled for surgery and preparing for the procedure.
Post-Surgery: Currently in the recovery phase following surgery.
Managing recurrence: Addressing symptoms or disease recurrence post-treatment.
Chronic Management: Actively managing ongoing treatment and management of symptoms.
Fertility Planning: Seeking treatment specifically for fertility concerns.
Other
9
What treatments have you undergone? (Please select all that apply)* This field is required.
Surgery
Hormonal Birth Control
Prescribed Medication
Alternative Medicine
Pelvic Floor Therapy
Other
10
How would you describe your current life stage?
11
What doctors and/or specialists make up your care team? (Please select all that apply)* This field is required.
OB/GYN
Obstetritian
Primary Care Provider (PCP)
Nutrionist / Dietitian
Functional / Integrative Doctor
Gastroenterologist
Reproductive Endocrinologist / Fertility Specialist
Acupuncturist
Therapist
Psychiatrist
Pelvic Floor Therapist
Massage Therapist
Other
12
Why do you want to be a MyAdvo Peer Advocate?* This field is required.
13
Which area of healthcare navigation are you most passionate about and/or knowledgeable in? (Please select all that apply)* This field is required.
Symptom Management
Getting to a diagnosis
Exploring Treatment Options
Providing Emotional Support
Alternative Treatments
Condition-Specific Research
14
Being a MyAdvo Peer Advocate means we treat all members of our community with compassion and respect. We honor their personal values concerning their care. We share our health journeys to provide emotional support and awareness of care & treatment options, so MyAdvo members can make their own informed decisions. Do you promise to uphold these values as a MyAdvo Peer Advocate?* This field is required.
15
How did you hear about MyAdvo? (Please select all that apply)* This field is required.
Instagram
Facebook
TikTok
LinkedIn
Friend / Family
Work
Healthcare Provider
Other
16
After submitting your Peer Advocate Application, you'll be directed to book time to meet with the MyAdvo Team via our Calendly Link!
Should be Empty: