Discovery Call with Dr. Kelsey

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Thank you for following your inner nudge to seek support along your fertility journey!

Please take a moment to fill out this short questionnaire which will help me know how best I can support you in this time.

Everything submitted on this form is confidential (not HIPPA protected) but for my eyes only.

I am so excited to connect with you & support you on your fertility journey! Following this intake, I will reach out to you directly to schedule a call.

If you have any questions please contact me at info@drkelseystang.com!

Email *

Full Name *

Preferred email address *

Phone number *

Where are you on your fertility journey?

just planning / preconception preparation

actively TTC for 1-12 months

actively TTC 12 - 24 months

actively TTC > 24 months

On a scale of 1-10, how willing and motivated are you to making changes that support optimizing fertility health & improving chances of pregnancy? *

Choose size and number per color

Comfortable & not wanting to change much

Motivated and ready to make changes to support getting pregnant

What are your top 3 desires in life right now?

What are your top 3 challenges in life right now?

What level of support are you seeking on your fertility journey?

Self-Guided Fertility Course, Accountability & Group Coaching

1:1 Consultations / Individualized Support

Becoming a Patient (Oregon Residents Only)

Other:

Most of the time, it takes 2 to tango. How willing is your partner to participating in optimizing health for fertility? *I invite you to be honest here, there is no wrong answer

Very willing & supportive of us doing what it takes to get closer to healthy pregnancy

Supportive of me, but not willing to do much themselves

Not very supportive to making changes at this time

Clear selection

In loving transparency and deep understanding of the costs of fertility care, what are you willing and able to invest in to optimize your fertility? What is your comfort level at this time? *

$0 - $1k

$0 - $2k

$0 - $4k

I'm not willing to invest monetarily at this time.

Required

*Note: if you're not willing to invest monetarily at this time, please tune into my Facebook Community group to stay up to date on free guides and resources.

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