About You

First Name

Last Name

Phone

Email *

Your Cycle Clues

How old were you when your period first started?

Under 10

11 to 14

15 or older

What is your cycle usually like?

35 days or longer

I never really know when it is coming

Like clockwork every month

Has anyone ever told you that you do not ovulate regularly?

Yes

Maybe

No

Have you had trouble getting pregnant?

Yes

Currently trying

No

Things your body may be signaling

Have you noticed thinning hair on the top of your head or along your part?

Yes and it worries me

A little

No

Do breakouts show up on your chin, jawline, or lower face?

Often

Sometimes

Rarely

Do you regularly remove hair from your face or chin?

Yes

Sometimes

No

Have you noticed thicker or darker hair in places that feel unexpected?

Yes

A little

No

How your body responds

Are you naturally hungry in the morning for breakfast?

Every day

Sometimes

I usually skip breakfast

Do you gain weight easily but struggle to lose or maintain it even when you are doing all the things?

Yes

Somewhat

No

Do you deeply crave sweets?

Often

Sometimes

Rarely

Does your body feel harder to work with when it comes to food or exercise?

Yes and it feels frustrating

Sometimes

No

How supported you have felt

Do you wake up tired even after a full night of sleep?

Most days

Some days

Rarely

Has a doctor, trainer, or other professional ever made you feel doubted or brushed off when you explained your habits?

Yes

More than once

No

One last thing

Would you like me to follow up with you?

Yes, I’d like to start with the Power Starter

Yes, I’d like a free PCOS strategy session

Not right now, I just wanted to check in

If you say yes, I will only reach out with supportive education and guidance. No spam. No

pressure.

Where should I send your result + free resource to help you take your next step?

Email Me

Call Me

I will schedule a consultation

Let’s talk about your PCOS story and what your body might be trying to tell you. Schedule a consultation now at: https://fusionhealthcoach.com/contact/

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