Month-round Menstrual Care: Womb (Uterine & Vaginal) Health
Thank you for connecting with me! Your responses to this survey will help me craft an appropriate service &  program that will help you heal your womb of disease & imbalance.

I look forward to sharing more details about the month-round menstrual care program with you! Peace, love, and healing from The Benevolent Life!
Name *
Phone number *
Email *
Address
Do you currently have a menstrual cycle? *
How long is your menstrual cycle?
Отменить выбор
Is your cycle regular (28 days from 1st day of bleeding to 1st day of next bleed)? *
If your cycle is not regular, what irregularities in timing do you experience?
Do you experience severe cramping or heavy bleeding with your menstrual cycle? *
Do you currently have any of the following womb issues? *
Обязательный вопрос
Do you have a regular womb care routine? If so, what is it? *
Would you be willing to work with me on a monthly basis to address the root of your womb imbalances? *
How many months would you be willing to participate in this program? I am thinking of including the following services: monthly vaginal steaming sessions & herb blends, community coaching, group Kemetic yoga sessions, nutrition education for womb health, womb energy readings with tarot cards or pendulum, and monthly one-on-one check-ins. *
Обязательный вопрос
Is there anything else that you would like me to know or any service that you feel I should include?
Отправить
Очистить форму
Никогда не используйте формы Google для передачи паролей.
Компания Google не имеет никакого отношения к этому контенту. Сообщение о нарушении - Условия использования - Политика конфиденциальности
Google Формы