WOMB Initiative Menopause Interest Survey

Welcome to our community survey!

At WOMB, our mission has always been "To empower and enrich the lives of women from all walks of life through information, resources and community during the journey into and through every stage of motherhood." 

While our vision roots itself in ensuring "that pregnancy, labor, birth and the postpartum are honored and respected as pieces of a sacred journey," we recognize that the journey of motherhood is deeply intertwined with the larger, sacred journey of womanhood itself.

Not every woman walks the path of pregnancy or raises a child, yet every woman carries the profound, life-giving power of menstruation. The closing of that particular chapter brings about a new period of transition—one that is just as powerful, captivating, and deserving of honor as any birth.

To support you through this phase, the WOMB Initiative is honored to propose a new, dedicated support group specifically for peri-menopausal and menopausal women. This space will be a sanctuary for sharing wisdom, finding community, and reclaiming your vitality. We are honored to share that the group will be facilitated by Rachel Cliche, a gut restorative nutrition therapist who specializes in supporting the feminine transition through menopause. 

Your voice is vital in shaping this offering. Please take a few moments to complete this brief survey so we can tailor this group to best serve your body, mind, and spirit during this profound transition.

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If you were to join a peri-menopause/menopause support and education community, what would be your primary reasons for joining?
What would prohibit you from wanting or being able to join a group like this?
If you feel like "nothing else has worked" for your symptoms or transition so far, what would this group need to offer to make it worth your time?
Which format do you prefer for our sessions?
Clear selection
Which time of day works best for your schedule?
What frequency (cadence) would you prefer for getting together?
Clear selection
Are there specific topics regarding perimenopause or menopause you would like to explore?
How would you rate your interest in attending a moderated support group?
Not interested
Very interested
Clear selection
Would you like to receive an invitation when we begin hosting support?
If you selected yes to the previous question, please provide your name and email address 
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