12-Week HA Recovery Program Application

First Name
Last Name
Email

Section 1: Menstrual & medical background

How long have you been missing/struggling with your period?*
How long have you been missing/struggling with your period?
Have you ever been evaluated for HA, PCOS, or other conditions?*
Have you ever been evaluated for HA, PCOS, or other conditions?
Are you currently using hormonal contraception, fertility medication, or undergoing treatment?
Have you ever been diagnosed with or treated for an eating disorder?*
Have you ever been diagnosed with or treated for an eating disorder?
If yes to the previous question, please share anything relevant about your recovery status that would help me support you safely.

Section 2: Motivation

Why is recovering your period important to you right now?
Not really...100%!
How committed do you feel to making changes to support period recovery? (1–10)
What kind of coaching style do you feel you respond best to?*
What kind of coaching style do you feel you respond best to?

Section 3: Program commitment & practicalities

Are you able to commit time weekly to the programme?*
Are you able to commit time weekly to the programme?
Are you financially able to commit to the investment if we decide it’s the right fit?*
Are you financially able to commit to the investment if we decide it’s the right fit?
How soon are you hoping to start?*
How soon are you hoping to start?
Is there anything else you'd like me to know before I review your application?