Her Glow Founding Member Interest Form
Share your interest in becoming a Founding Member of Her Glow and help us shape a women's wellness membership tailored to your needs.
Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you currently a patient at Gold Ivy Wellness?
*
Yes
No
I have an appointment scheduled
I've been a patient in the past
What are you most interested in receiving support with? (Select all that apply)
*
Hormones / Perimenopause / Menopause
Fatigue / Feeling "off"
Metabolism / Weight Management
Vaginal Health
Recurrent BV or Yeast Infections
Vaginal Dryness / Irritation
Pelvic Pain
Pain With Sex
Low Libido / Sexual Wellness
Thyroid Health
Healthy Aging
Ongoing Women's Wellness Care
I'm not sure — I just want someone to help me figure out what's going on
Other
What sounds most valuable to you about Her Glow? (Select all that apply)
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Having a women's health provider who knows my history
Quarterly comprehensive wellness visits
Access to acute women's health visits when something comes up
Being able to message my provider between visits
Priority scheduling
Ongoing hormone or metabolic management
Support with vaginal, pelvic, or sexual health
Exclusive member pricing on select GLP-1 programs
Exclusive member pricing on peptide therapies
Discounts on aesthetic and healthy-aging treatments
Having one place to go for my women's wellness needs
Something else
If Her Glow feels like the right fit, would you be interested in becoming a Founding Member at $149/month?
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Yes — I want first access!
Probably — I'd like to learn more first
Maybe — I'm curious
I'm just gathering information right now
How would you prefer to hear from us when enrollment opens? (Select all that apply)
*
Text
Email
Phone call
Is there anything you wish you had more support with when it comes to your health?
Join the Interest List
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