Fertility Questionnaire: {her}strategies
Thank you for visiting herstrategies.com. Any feedback is greatly appreciated.
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NAME: *
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PHONE: *
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AGE: *
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SEX: *
RELATIONSHIP STATUS: (single, engaged, living with a partner, exclusive relationship, open relationship, married, etc.)
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FAMILY: Did you give birth to any children? If yes, age(s) and natural vs fertility treatments?
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Q1: Have you ever started fertility treatments or froze your eggs? If yes, when (age), how many times, reasons?
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Q2: Is having a family someday part of your goals?
Q3: Is this the first time you’ve heard of egg freezing? If not, how did you hear about it?
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Q4: What type of birth control do you use?
Q5: Have you ever had a fertility appointment or purchased AMH testing via at-home kit or clinic? If yes, what did you have done, the amount spent, and results?
Q6: Are you planning to freeze your eggs? If yes, do you have a timeline when (age) or how many times you would like to freeze?
Your answer
Q7: How often do you exercise?
Q8: On a scale of 1-10, how serious are you about freezing your eggs? (10 = most serious | 1 = not serious) Any specific barriers, concerns, fears, or hesitations keeping you from moving forward?
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Q9: Have you ever attended an egg freezing event or a fertility seminar? Were all your questions and concerns answered?
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Q10: Do you want more information about reproductive health, fertility, or egg freezing? If yes, what information would you like?
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Q11: Anything else you’d like to suggest or share?
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Thank you so much for your time! You're the best!
We truly appreciate your candid answers and will be in touch immediately help assist you with your fertility goals.
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