01 - About you 02 03 04 05 06 07

5. What type of work do you do?

01 02 - Your experience 03 04 05 06 07

Section 2 of 7

Your experience of midlife change

Your answers help us understand the group and do not suggest that the product will improve a particular symptom.

01 02 - Your experience 03 04 05 06 07

6. Which statement best describes where you are currently? *

I think I may be entering perimenopause

I am in perimenopause

I am approaching menopause

I have reached menopause within the past two years

I reached menopause more than two years ago

I am unsure

None of these describes me

01 02 - Your experience 03 04 05 06 07

7. Have you noticed changes in how your body feels or behaves during this stage of life? *

01 02 - Your experience 03 04 05 06 07

10. In your own words, what has changed and why does it matter to you?

01 02 03 - Current approaches 04 05 06 07

Section 3 of 7

Current approaches and attitudes

01 02 03 - Current approaches 04 05 06 07

11. Are you currently using hormone replacement therapy, commonly called HRT? *

Yes

No, but I have used it previously

No, but I am considering it

No, and I have never used it

01 02 03 - Current approaches 04 05 06 07

18. Other advice source (optional)

19. Is there a particular person, clinic or podcast whose advice you value?

20. What is the maximum amount you would currently be willing to pay for a 30-day supply of a dual supplement containing live bacteria and prebiotic fibre? *

01 02 03 04 - Taking part 05 06 07

Section 4 of 7

Programme participation

01 02 03 04 05 - Suitability 06 07

Section 5 of 7

Just a few technical questions before we finish.

These help us check suitability and make sure you have the information you need.

Safety and suitability

The programme team may contact you privately to determine whether participation would be appropriate. Please do not enter detailed medical information in this form.

01 02 03 04 05 - Suitability 06 07

Full ingredient list

Capsule ingredients

Bifidobacterium longum
Lactobacillus crispatus
Lactobacillus rhamnosus
Bifidobacterium adolescentis
Microcrystalline cellulose HPMC hydroxypropylMethylcellulose shell

Sachet ingredients

Biotis GOS-OP galacto-oligosaccharide

01 02 03 04 05 - Suitability 06 07

31. Are you pregnant, trying to become pregnant or breastfeeding? *

Yes

Prefer not to say

32. Do you have an allergy or known sensitivity to any ingredient listed here? *

Yes

Unsure

33. If you selected Yes or Unsure, please identify the relevant ingredient or concern.

01 02 03 04 06 06 - Recruitment source 07

Section 6 of 7

Recruitment source and independence

01 02 03 04 06 06 - Recruitment source 07

40. Have you previously participated in research, product testing or another FemmeBiome activity?

Yes

Unsure

01 02 03 04 06 07 - Contact & permissions

Section 7 of 7

Contact and permissions

Email *

Phone *

Full Name *

Review your answers

Review your answers in the previous six sections before submitting.

Programme application permission - I understand that I am applying for the FemmeBiome Pioneer Programme and that completing this application does not guarantee a place. I give FemmeBiome permission to use the information provided to assess my eligibility, assemble a balanced cohort and contact me about this application.

I confirm that the information I have provided is accurate to the best of my knowledge.

Optional updates from FemmeBiome

I would like to receive news, product information and future opportunities from FemmeBiome. Leave unticked unless you wish to give permission. This choice does not affect selection.

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