First Name
*
Last Name
*
Email
*
1. Where are you in your fertility journey?
*
A. Just starting to think about family building
B. Actively trying to conceive
C. Seeking fertility testing
D. Exploring treatment options (IUI, IVF, Egg Freezing)
E. Currently undergoing treatment
2. Have you had any fertility-related testing completed?
*
A. No testing yet
B. Basic bloodwork only
C. Fertility hormone testing
D. Comprehensive fertility evaluation
E. Multiple evaluations and consultations
3. How confident are you in understanding your fertility options?
*
A. Not confident at all
B. Slightly confident
C. Somewhat confident
D. Very confident
E. Extremely confident
4. Have you selected or consulted with a fertility specialist?
*
A. No
B. Researching providers
C. Scheduled my first consultation
D. Consulted with one provider
E. Consulted with multiple providers
5. Do you know whether your health insurance includes fertility benefits?
*
A. No
B. Unsure
C. Limited coverage
D. Some fertility coverage
E. Comprehensive fertility coverage
6. Which statement best describes your fertility treatment budget?
*
A. No budget identified
B. Concerned about affordability
C. Exploring financing options
D. Have savings allocated
E. Financially prepared
7. Are you aware of fertility grants, scholarships, employer benefits, or financing programs?
*
A. Not aware of any
B. Heard of them but don't know where to start
C. Researching options
D. Applied for some opportunities
E. Actively utilizing resources
8. How strong is your fertility support system?
*
A. No support system
B. Limited support
C. Some support
D. Strong support
E. Excellent support network
9. What is your biggest fertility challenge right now?
*
A. Not knowing where to start
B. Choosing the right specialist
C. Understanding treatment options
D. Affording treatment
E. Managing stress and uncertainty
10. How ready are you to take the next step in your fertility journey?
*
A. Just gathering information
B. Planning within the next 12 months
C. Planning within the next 6 months
D. Planning within the next 90 days
E. Ready now
Fertility Assessment Total Score
Get My Fertility Planning Score
No spam. Just your results and helpful fertility planning resources.
