Care Readiness Check-In

Thank you for taking a moment to complete this short survey.

As we prepare for scheduling to open, this survey helps our clinical team plan next steps and ensure we’re supporting patients appropriately. Some questions may overlap with prior surveys. We appreciate your patience, as gathering this information together allows us to plan more accurately.

Responses are optional and for planning purposes only. Completing this survey does not establish care or confirm patient status.

This survey should take less than 2 minutes.

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Email *
Legal First Name  *
Legal Last Name *
Phone Number *
DOB *
MM
/
DD
/
YYYY
Birth Sex *
Required
Are you a Donor patient? *
When scheduling opens, which best applies to you? *
Which insurance do you currently use?
 *
You may have shared this before. We ask again here to ensure accuracy as we prepare for scheduling.
When are you hoping to pursue fertility care in 2026? *
Which monitoring site are you most likely to visit? *
Are you currently taking any of these medications: Estrace, Testosterone, Growth Hormone or Birth Control? *
Have you requested your medical records from your prior provider(s)? *
We will share instructions soon on how to securely transfer records to our team when scheduling opens.
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