Emotional PMS / PMDD Survey
Thank you for taking the time to share your experiences!

Let me first just say that you are not alone, and I have experienced just about everything described in this form at one time or another. 

It took me years to figure out what was happening, why it was happening, and how to heal myself. 

Now my intention is to create a program that will shorten the learning curve for other people suffering in the way I suffered for so long.

My goal is to help thousands of people get off the rollercoaster of emotions and life disruptions that the experience of intense emotional PMS / PMDD can create. 

Your answers will help me know the best ways to structure my program for maximum positive impact.

Absolutely EVERYTHING in this form will be kept completely confidential !!

Thank you for your trust.
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Email *
Please share your first name
Please share your preferred pronouns
What is your current age? *
At what age did you start to experience intense emotions along with your menstrual cycle? *
How frequently do you experience an intense wave of emotions with your menstrual cycle? *
What emotions do you experience when you're having PMS / PMDD?
Please rate on a scale of 0 - 5,
with 0 meaning, "I never experience this!"
and 5 meaning, "This experience is extremely common." 
*
0
1
2
3
4
5
Low-key irritation that slowly builds into anger
Sudden, explosive bouts of anger
Constant RAGE at EV-ER-Y THING
Weepiness or softly crying all day long
Sudden, stormy sobbing tears
Fighting with loved ones over things that don't really matter much
"I hate everyone, get away from me"
Trouble concentrating on work or school
Brain fog / forgetfulness
Depression or disinterest in regular activities
Exhaustion: must. stay. in bed.
Apathy about things that usually matter to you
Low key anxiety running in the background
Full-on, gasping panic attacks
Sensory overload reached much more easily
Disordered food intake (too much OR too little)
Desiring rich or sugary foods
Intrusive and/or repetitive thoughts
Self-harm (ideation or actualization)
Suicidal thoughts / feelings
Please select the option that describes you best *
Please rate the following on a scale of 0-5 
0 = never tried it
1 = tried it, and it was totally unhelpful for alleviating emotional PMS
5 = tried it, and it has been miraculously helpful for alleviating emotional PMS
*
0
1
2
3
4
5
Hormonal birth control
Hormonal therapy not related to birth control (like progesterone cream)
Antidepressants / anti-anxiety meds
Herbal / natural remedies
Nutrition / changing your eating habits
Acupuncture
Counseling / talk therapy
DBT / journaling
Physical exercise
Spiritual practices
Yoga, tai chi, other physical / spiritual combo
Please share any details about your experiences described in the question immediately above, that you are comfortable telling me about...
Was there a life event which seems to have triggered or intensified your emotional PMS / PMDD experience? Check all that apply
Please share any details about your experiences described in the question immediately above, that you are comfortable telling me about...
In your own words, please tell me how your experience of emotional PMS / PPDM is (or was) negatively impacting your life:
In your own words, please tell me how 'getting off the rollercoaster' of emotions would change your life (or how it HAS changed your life, if you no longer experience emotional PMS / PMDD):
Have any of these statements ever been true for you?
Which forms of support would be of interest to you? 
Please rate from 1 to 4 –
1 = hell no
2 = meh
3 = yeah sure I'd try that
4 = zOMG ... YES please !!
*
1
2
3
4
Live group classes (passively watching)
Live group classes (small & interactive)
Pre-recorded teaching videos
Teaching material in audio-only format
Teaching material you can read
Workbooks and journaling prompts
Online social media community
Access to discounted supplements
If you could name a $$ amount that you'd be willing to pay for a program that would get you off the rollercoaster of unbearable, disruptive emotions, what amount would you feel great about paying?

(total amount, knowing it could be paid in installments)
*
Is there anything else that you want to share with me about your experiences and/or the support you would like to receive?
Submit
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