Are your menstrual cycles between 25-35 days every month? *

Yes

No

Do you notice signs like cervical mucus changes or positive ovulation tests? *

Yes

No

Have you been diagnosed with insulin resistance or prediabetes? *

Yes

No

Do you have other hormonal symptoms, like acne, excessive hair growth, or hair thinning? *

Yes

No

Do you sleep well and do you wake up feeling rested? *

Yes

No

Do you experience high levels of stress, anxiety, or mood swings? *

Yes

No

Have you tried any stress-reduction techniques like mindfulness, yoga, or acupuncture? *

Yes

No

Are you working with an OB-GYN or fertility specialist? *

Yes

No

Would you be open to making dietary or lifestyle changes to support fertility? *

Yes

No

How soon are you hoping to conceive, and do you have a timeline in mind? *

First Name

Last Name *

Email *

Phone *

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