CYCLE CLARITY 1:1 PROGRAM

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Hello there!

Thank you for filling out this form to start the communication about your Menstrual health and wellness needs! Once I review your information, I will be in touch via phone or email to review needs, expectations and next steps.

*This is a 3-4 month Program that requires at least 6-8 sessions depending on your Menstrual Health and Fertility needs, so we do want to make sure we are a good fit.

*(Payment is required upon confirmation of partnership)

Email *

Phone number *

First and Last Name *

What time zone are you in?

What intentions do you have for working with me in the 1:1 Cycle Clarity Program? *

If you are currently trying to conceive, how long have you been trying?

Which statement best applies to you? You may check more than 1 box if needed. *

I have regular menstrual cycles (24-35 days in length)

I have irregular menstrual cycles (consistently longer than 35 days or shorter than 24 days)

I am experiencing challenges with my cycle (ex; period pain, or PMS or unusual bleeding)

I am on or recently off hormonal contraception

I am postpartum breastfeeding exclusively

I am postpartum breastfeeding partially

I am postpartum not breastfeeding

I am unsure of what my menstrual cycle is like and am looking to learn more

I am a teen and new to cycling and I am wanting to learn body literacy

I am (or think I am) Perimenopausal and looking for support

I want to learn the Sympto-Thermal Method for birth control

I want to know more about my body and how to use my menstrual cycle as a vital sign of health and wellness

I am NOT in need of birth control, I am seeking education and overall better menstrual health

Required

Have you used hormonal birth control before? (ie; the pill, the patch, the shot, the implant, the ring, or the hormonal IUD)? *

yes

If you have used hormonal contraceptives, please describe below what method(s) you used as well as the duration of each.

Have you started charting your menstrual cycle already? *

YES

How would your rate your understanding of the fertility awareness method?

I know nothing!

I am extremely confident

Clear selection

Please list any previous resources (ie, books, podcasts, courses) you have used in the past to learn about Fertility Awareness.

What are you looking to achieve by the end of the 1:1 Cycle Clarity Program? *

For the best results, committing to a 3 Month partnership of charting your cycle/or paying attention to your cycle daily is optimal. Is this something you feel you can commit to depending on your needs? *

Yes

Maybe

Is there anything else you would like me to know?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms