BRIDGE TO BABYLAND
Email
First Name
How long have you been Trying To Conceive
Age
Partners Age
Country or US State How long are your cycles (28-36 days) First day of your last period (LMP) Describe Your Period (length, flow, heavy, pain) Are you able to "predict" ovulation (yes or no) If so, how do you Predict Ovulation? Choose all that apply Pain Ovulation Test (urine) Basal Body Temperature Cervical Mucus Monitor Ferning Microscope Pain Other How long is your Luteal Phase Ever Been Pregnant If so, how many times? How many Children do you have Have you had any miscarriages? If so, at what week How many hours of sleep do you get per night Are you a Vegetarian? If so what kind What are your favorite comfort foods? How tall are you (height) How much do you weigh (weight) Describe your physical health Any Physical Challenges? Any Surgeries (e.g., lap, C-section, D&C etc.) Are you living with pain? What do you do for a living? (Occupation/Profession) Are you under any stress? If so, what is creating stress in your life Do you have a stressed body part (e.g., neck, headaches, back pain, etc.) Family Medical History (e.g., PCOS, heart attack, early menopause, fibroids, miscarriage) Medical Conditions Medications
How long are your cycles (28-36 days)
First day of your last period (LMP)
Describe Your Period (length, flow, heavy, pain)
Are you able to "predict" ovulation (yes or no)
If so, how do you Predict Ovulation? Choose all that apply Pain Ovulation Test (urine) Basal Body Temperature Cervical Mucus Monitor Ferning Microscope Pain Other
How long is your Luteal Phase
Ever Been Pregnant If so, how many times?
How many Children do you have
Have you had any miscarriages? If so, at what week
How many hours of sleep do you get per night
Are you a Vegetarian? If so what kind
What are your favorite comfort foods?
How tall are you (height)
How much do you weigh (weight)
Describe your physical health
Any Physical Challenges?
Any Surgeries (e.g., lap, C-section, D&C etc.)
Are you living with pain?
What do you do for a living? (Occupation/Profession) Are you under any stress? If so, what is creating stress in your life Do you have a stressed body part (e.g., neck, headaches, back pain, etc.) Family Medical History (e.g., PCOS, heart attack, early menopause, fibroids, miscarriage) Medical Conditions
Are you under any stress? If so, what is creating stress in your life
Do you have a stressed body part (e.g., neck, headaches, back pain, etc.)
Family Medical History (e.g., PCOS, heart attack, early menopause, fibroids, miscarriage)
Medical Conditions
Medications
Hopes and/or fears
What do you think is going on
Anything not covered
Your US Phone
For immediate attention call: 727-643-8796 Or contact me via email: Click to open email to Momma Kath
