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Make Every Egg Count Application

If you are ready to perfect your pregnancy prep and return your body to it’s fertile self then you are in the right place.

This application process is meant to verify that you understand the program and that you are open to my coaching style. The goal is to serve women who will get the most benefit from my expertise.

Name *

First Name

Last Name

Email *

Phone *

(###)

###

####

Age *

How did you find Moon Catching? *

Are you trying to conceive in the next 12 months? *

Yes

No

Do you already have one or more children but are struggling to have the next? *

Yes

No

Have you experienced one or more miscarriage/pregnancy loss? *

Yes

No

If you have used birth control in the last 4 months, please list the date you stopped. *

What elements of your cycle do you track? *

Select all that apply

Days of menstrual bleeding

Basal body temperature (BBT)

Types of discharge

Days of discharge

Day of ovulation

Number of days post ovulation

Cervical position

LH surge

Progesterone levels

None

What is the biggest obstacle keeing you from finding your root cause and unblocking your fertility? *

Please list any sypmtoms that highlight low fertility and hormone imbalance *

Select all that apply in the last 12 months

PMS

PCOS

Endometriosis

Fibroids

Miscarriage

Cervical dysplasia (abnormal cellular changes)

Chronic vaginal infections

Cravings (sugar, carbs, salt)

Hormonal migraines and headaches

Irritability, mood swings, depression

Family or personal history of breast, endometrial, or other gynecologic cancer

Hair loss

Menstrual cramps

Irregular, skipped, or painful periods

Monthly breast tenderness and lumps

Sleep problems

Low (or no) sex drive

Vaginal dryness, no or scant cervical mucus

Weight gain

Osteopenia or osteoporosis

Anxiety or depression

History of prenatal or postpartum depression

Thyroid problems

None

Describe your menstrual cycle *

Select all that apply/occured in the last 12 months

Clotting

Spotting before, right after, or between periods

Longer than 35 days

Shorter than 20 days

Less than 3 days of bleeding

More than 7 days of bleeding

Painful

Pale, watery bleeding

Dark red/brown/chocolate

Heavy bleeding, frequently changing pad/tampon/menstrual cup

Normal

List the areas of your life where you could be more consistent: *

Clean, healthy eating

Staying hydrated

Adequate sleep

Movement and exercise

Stress management

Self love, self care

Why does working with me and the MEEC program stand out from other options to improve your fertility? *

Compared to other programs or assisted methods

On a scale of 1-5, how important for you to pinpoint and address your cycle imbalance, improve your egg health, and get pregnant naturally? *

1-Lowest 5-Highest

Can you handle leaving your comfort zone for potentially radcial changes to your lifestyle and nutrition, with an intense supplement protocol for the next 4 months? *

Yes

No

Please share anything else you would like me to know *

If you could increase your fertility and chances of getting pregnant naturally without the guesswork, would you be interested? *

What is your current situation? *

Are you willing to make a 4 figure investment to unblock and restore your fertility for this pregnancy and the next? *

Yes

No

THANK YOU!

I will review your application and contact you soon.

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