Apply to work with me here

1
Math Challenge* This field is required.Validate you are human
2
Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
Did you watch the brief training?* This field is required.
YESNO
5
If yes, what was your biggest take away/aha moment from watching the video?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
6
Are you interested in getting pregnant in the next 3-6 months?* This field is required.
YESNO
7
On a scale on 1-10 how committed/interested are you in getting pregnant in the next 3-6 months?* This field is required.Where 1 = just a little and 10=I want this now!
8
What do you think your biggest challenge to getting pregnant naturally is?* This field is required.
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
9
Are you currently working with a doctor, specialist, acupuncturist or anyone else?* This field is required.
YESNO
10
Have you had kids previously?* This field is required.
Not yet, I am trying for my first
Yes, I have kid(s) and I'm struggling to get pregnant again
11
Have you ever experienced a pregnancy loss?If so, my heart goes out to you. I know how devastating that is!
YESNO
12
Have you already tried any fertility treatments? If so, what? When? * This field is required.Mention anything that applies
13
How much would you estimate you have already spent on fertility treatments?
Please Select
Please Select
0- $100
$100 - $1,000
$1,000 - $10,000
$10,000 - $20,000
$20,000 +
14
Have you already identified what the barriers are to your conception? Have you done any testing or received any diagnosis? (you or your partner)* This field is required.
15
What would it be worth it to resolve your fertility challenges, get & stay pregnant and have your baby?
0-$500
$500-$5,000
$5,000-$10,000
$10,000-$25,000
$25,000+ (Priceless)
16
If we both agree that the Fertile Foundations Program is a good fit, I am ready and able to make the investment.* This field is required.
I have funds available to make an investment such as coaching which will help me understand my unique root causes, get a clear plan & fast track my process to boosting my healthy & fertility naturally which will have results that will last a LIFETIME.
I have access to credit and am prepared to make an investment in myself & future family because completing my family is a need/goal I am serious about.
I do not have access to resources & was looking for something low cost or free.
17
I understand that IVF treatments, medications, and other medical procedures can cost upwards of $100,000. I work with women 1:1 over 3-6 months who want to get pregnant naturally and I understand the total investment starts at $3,000 USD…* This field is required.
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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