Fertile Woman Program Application

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Please note due to the high demand for this program, the investment is currently £300 per month for a minimum of 3 months, so before you continue, is that doable for you? *

Yes, I'm happy to invest in my health and wellbeing

No, but I'd be interested to hear about an extended payment plan

No, but I'd like to be put on your cancellation list for any last minute single session appointments

Required

Name and age *

Email and phone no *

Are you trying to conceive? If yes, how long for? *

Have you seen a medical fertility specialist? If yes, did they recommend any treatment or have you had any assisted conception treatments (clomid, ovulation inducation, IVF, ICSI etc) - please give dates if possible *

Have you been given any diagnosis? (endometriosis, pcos, poor egg quality, poor sperm, unexplained?) *

Have you worked with a holistic fertility specialist like myself before? If yes, what treatments did you get? *

Which parts of my Fertile Woman sessions interest you the most (you can pick more than one) *

Understanding my cycle more and helping to regulate it and my hormones

Improving blood flow to my womb and other organs

Switching off and de-stressing with massage and reflexology

Releasing emotional blocks and changing my mindset

ALL OF THE ABOVE

Required

When are the best times for you to have sessions *

Any day or time, I'm flexible

Weekday mornings

Weekday afternoons

Weekday evenings

Saturday

Sunday

Required

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