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Fertility Foundations Group Program
Please complete the following application form to the best of your ability.
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Email
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Your email
Full Name:
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Your answer
Primary Phone Number:
Your answer
How/where did you hear about the Fertility Foundations program?
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Your answer
How long have you and your partner been actively trying to conceive?
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Your answer
How would you describe your fertility journey to date?
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Your answer
(OPTIONAL:) Have you been diagnosed with any condition that my affect fertility? (i.e. PCOS, endometriosis, thyroid disfunction, uterine fibroids, etc...)
Your answer
(OPTIONAL:) Have you or your partner completed any fertility-related testing (i.e. FSH, Estradio, DHEAs, follicle count) or received any fertility treatments (ie. ovulation induction, IUI, IVF)?
Your answer
(OPTIONAL:) Have you tried any "natural" fertility methods/strategies? (i.e. nutrition & lifestyle changes, cycle charting, basal body temperature, TCM & acupuncture, etc...)
Your answer
Why are you interested in joining this group? Please check all that apply.
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To learn about natural conception methods such as the Fertility Awareness Method
To learn and implement Dietary & Lifestyle changes that support fertility
To have the professional guidance of a Registered Holistic Nutritionist (RHN)
To receive direction and emotional support from a Fertility Support Practitioner (FSP) in training
To have access to hands-on tools like the Meal Planning digital platform (& app)
To build relationships and have support from a community of like-minded women
Other:
Required
The next Fertility Foundations GROUP program is scheduled to begin February 1st, 2023. Are you interested in any additional fertility & nutritional support services on an INDIVIDUAL basis between now and then?
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Yes, I am interested
No, I will happily wait until February
Maybe, I need more info
(OPTIONAL:) Is there anything else that you would like me to know about yourself, your journey, or how I can support you in your fertility goals?
Your answer
CONSENT
After reviewing your application form, I may contact you with questions related to your application. Once we have secured your spot in the program, I will send you email updates in the weeks leading up to the start date. Please acknowledge and consent to my contacting you.
Do you consent to being contacted by email or phone with follow up questions regarding this form?
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Yes, I consent to being contacted.
No, please do not contact me.
Do you consent to receiving email updates about the Fertility Foundations program as the start date approaches?
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Yes, I consent to receiving these email updates
No, I do not consent to receiving these updates
Do you consent to receiving Feed Fertility promotional emails, such as news and offers for other fertility-related programs, courses, and services?
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Yes, I consent
No, I do not consent
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