Fertility Questionnaire: {her}strategies
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Email address *
NAME: *
PHONE: *
AGE: *
SEX: *
RELATIONSHIP STATUS: (single, engaged, living with a partner, exclusive relationship, open relationship, married, etc.)
FAMILY: Did you give birth to any children? If yes, age(s) and natural vs fertility treatments?
Q1: Have you ever started fertility treatments or froze your eggs? If yes, when (age), how many times, reasons?
Q2: Is having a family someday part of your goals?
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Q3: Is this the first time you’ve heard of egg freezing? If not, how did you hear about it?
Q4: What type of birth control do you use?
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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?
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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?
Q7: How often do you exercise?
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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?
Q9: Have you ever attended an egg freezing event or a fertility seminar? Were all your questions and concerns answered?
Q10: Do you want more information about reproductive health, fertility, or egg freezing? If yes, what information would you like?
Q11: Anything else you’d like to suggest or share?
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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