First Name
Last Name
Phone
*
Email
*
How long have you been trying to conceive?
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Less than a year
More than a year
What kind of support are you currently looking for?
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A DIY program
Private/personalized support with a practitioner
What are you willing to invest into optimizing your health and fertility?
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My budget is under $500
I’m willing to invest if it’s the right fit
Is your partner supportive and on board with working together to improve your fertility?
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No/ We haven’t talked about it
Yes we are on the same page