Calm & Fertile Mentorship Application Form
Thank you for your interest in joining the Calm & Fertile Mentorship! This is a 3 month personalised fertility program designed to help lay the foundations for pregnancy, and finally feel in control of your conception journey. Please answer the following questions honestly - there are no “right” or “wrong” answers. This helps me understand if this is the right fit for you.
Personal Details
Name
First Name
Last Name
Email
example@example.com
Age
Location / Timezone
Your Fertility Journey
2. How long have you been trying to conceive?
I've not started yet
Less than 6 months
6 months to 1 year
1 - 2 years
Over 2 years
Have you received any fertility-related diagnoses?
PCOS
Endometriosis
Unexplained infertility
Low ovarian reserve
Other
If you answered 'Other', enter it below:
4. Are you currently working with a fertility clinic or specialist?
Yes
No
If you answered 'Yes', please specify below:
5. Have you had any fertility treatments or tests?
Hormone testing
AMH/FSH testing
Ultrasounds/follicle tracking
IUI or IVF
Other
Can you elaborate on the results or other testing done not listed above:
What are you looking for?
What’s your biggest frustration right now when it comes to getting pregnant?
What would having personalised plan change for you emotionally and physically?
Why do you feel now is the right time to commit to this journey?
Commitment
This is an investment of of £1200. Are you able to commit to this investment at this time?
Submit
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