InstagramThis field is for validation purposes and should be left unchanged.Name* First Last Email* Phone/Mobile*Age*Partners Age*Profession*Where did you hear about me and my work?*Please give a summary of the health challenges you would like help with...*Have you been pregnant before?* Yes No What is the current diagnosis, if you have one?*What have you tried so far in terms of fertility treatment?*(both medically and complimentary medicine)Have you ever had talking therapy before?* Yes No What 3 things are stressing you the most about your fertility situation?*What changes have you made so far to improve your fertility, if any?Do you follow any specific diet or exclude any particular food groups from your diet?*i.e Vegan, Paleo, Keto, Dairy or Gluten free etc….. Please state which, for how long and the reasons why?Clare, here’s something else I want you to know...*Data Privacy*This form collects your name, telephone number and email address along with your message so that our team can communicate with you and provide you with assistance. Please check our Privacy Policy to see how we protect and manage your submitted data. I consent to my submitted data being collected and stored Δ
