Help change the future of care for endometriosis!

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Apply for a Sponsored Subscription to ELANZA From time to time as they become available, we match patients with donor grant sponsored spots to offer all of ELANZA's services free or at discounted rates, thanks to the generous donations of our individual and corporate partners.

Please complete the following form to apply for coverage through our sponsored programming as these in-demand places become available! Reach out to us at info@elanzawellness.com with any questions!

Your answers are confidential and analyzed by our trusted team. If you would like to read more about our team, click here or our privacy policy here.

Thank you!

Email *

What is your full name (first and last)?

What city, state and country do you live in? e.g. Dallas, Texas, USA

Which health conditions are you living with? (Check all that apply) *

Endometriosis

Endometrioma

Adenomyosis

Other:

If yes, how long ago were you diagnosed? *

Within a year

1-3 years ago

3-5 years ago

5+ years ago

What stage is your endometriosis currently at, if known? (More info) *

Minimal (Stage I)

Mild (Stage II)

Moderate (Stage III)

Severe (Stage IV)

Unsure

Other:

Have you received any of the following treatments? (Check all that apply) *

Hormone therapy (e.g. pill, a shot or injection, nasal spray or IUD)

Pain medications (e.g. nonsteroidal anti-inflammatory drugs, also called NSAIDS)

Surgical treatment

Full or partial hysterectomy

Counselling or therapy

Group therapy

Physiotherapy

Acupuncture / acupressure

Therapeutic massage

Somatic movement e.g. yoga, Pilates

Nutritionist / Dietitian or dietary changes

Supplements

Other:

Required

What is your best estimate of the financial burden endometriosis has placed / places on you, per year?

When you add up spending on things like:
- Medical bills or co-pays
- Over the counter medications and prescriptions
- Appointments
- Holistic treatments
- Nutrition/special foods
- Supplements
- Impact on your job

- Time spent researching

Zero

Up to $500 per year

$500 - $1500 per year

$1500 - $2500 per year

$2500 - $3500 per year

$3500 - $5000 per year

Over $5000 per year

Along your endo journey, have you ever felt disbelieved or had your symptoms or experience downplayed or brushed off by a healthcare professional? *

Yes

Fill in the blank. My endo journey would have been different if... *

Is there anything else you'd like to tell us? *

Is there anything else you'd like to share with our team that could help us understand your experience of endometriosis better or how to improve care?

Would you like to receive further information about the launch of ELANZA's endo care program and beta user opportunities? *

Yes

Would you be open to a quick chat with the founders so they can hear your story?

Please book a time with us here. Your answers will be confidential.

Thank you!

If you know other people who would benefit from hearing about ELANZA for Good, please share the link so they can complete the survey too.
For any questions, feel free to email: info@elanzawellness.com

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