1) What is your first name:
2) How old are you (birthday)?
3) What country do you live in?
4) Do you have regular cycles? (menses every 28-34 days, give or take a few days) If not regular, how many per year?
5) Are you able to predict your ovulation? If so, how?
6) How long is your luteal phase (number of days after ovulation)?
7) How long have you been trying to conceive?
8) When was your last menstrual period?
9) Describe your periods (pain, length, amount):
10) Have you ever been pregnant? If so, how many children do you have?
11) Have you had any miscarriages? If so, how far along were you?
12) How many hours of sleep do you get a night (average)?
13) Describe your physical health:
14)Are you a vegetarian? If so, what kind?
15) What is your weight/height?
16) Any physical challenges, medications, allergies, et cetera?
17) Are you living with pain?
18) Describe your hopes and fears and those of your partner:
19) What do you think is going on?
20) Contact info: