Client Intake Form | DoctorTazz

Welcome to the Fertility Coaching Client Intake Form.
Please provide us with the following information:

Name

Age

Phone

City and state/country of residence:

What prompted you to seek fertility coaching?

Have you been diagnosed with any medical conditions related to fertility? If so, please specify:

Have you undergone any fertility treatments in the past? If so, please specify:

Are you currently undergoing any fertility treatments? If so, please specify:

How long have you been trying to conceive?

Have you experienced any pregnancy losses? If so, please specify:

Have you discussed your fertility concerns with a healthcare professional? If so, please specify:

Have you explored any alternative therapies or practices related to fertility? If so, please specify:

Have you been following a specific diet or exercise regimen to enhance your fertility? If yes, please describe.

How do you cope with stress and anxiety related to infertility?

What are your primary goals for fertility coaching?

How do you envision a fertility coach supporting you in your journey?

Is there anything else that you would like to share about your fertility journey or your goals for this coaching program?