The "off the pill" Program Application
Hi there angel! 🤍
Thank you for your interest in applying to the "off the pill", which will help regain balance and empower you in this new phase of your life! To better understand where you are at in your health journey with birth control, please answer the following brief questions. You will be receiving an email shortly as to your application status for this life changing program!

The purpose of this form is to make sure that we're both a great match for each other so that you receive the most benefit from the "off the pill" program, and so that I can better understand how we can work together to heal from the root, since this program is completely personalized to you. If you have any questions or concerns, please shoot me an email at periodpmdd@gmail.com. Thank you for the energy put into this form.


Sending you light and love on this incredibly honorable journey you are on!

- Nat, founder & CEO of "period"
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E-Mail-Adresse *
Name *
Which stage are you at in getting off of birth control?
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If you had a magic wand that could eliminate any symptom you have been experiencing in getting off of birth control what would that be?
What are you hoping to gain from participating in the "off the pill" program? *
What kinds of alternative medicine have you tried before, and what has resonated the most with you/ has proven to be the most effective, if any?
Do you have any questions/concerns about the program? (We can go over these during our 15-minute intro call is scheduled- pending application approval)
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