Cycle Assessment Name * First Name Last Name Phone * (###) ### #### Email * DOB * MM DD YYYY Time of Birth (if known) Hour Minute Second AM PM Place of Birth (city, state) * Do you currently get a menstrual period? Yes No Irregularly When was the first day of your last period? MM DD YYYY Do you notice any common patterns or symptoms with your cycle (cramps, breast tenderness, spotting, emotional changes)? How many pregnancies have you experienced? Live births Pregnancy releases None For each pregnancy or pregnancy release, please share how long it took for your cycle to return: Year | Type (birth or release) | Breastfeeding? | Cycle returned after ___ weeks/months | Notes Are you currently breastfeeding? Yes—exclusive Yes—partial/weaning No If yes, what is baby’s age? And last menstrual period? Are you currently using any form of birth control? Not at the moment Hormonal pill Condom or barrier method Withdrawal method IUD (hormonal or copper) Implant (e.g. Nexplanon) Natural or fertility awareness method Hormonal shot (e.g. Depo-Provera) Vaginal ring (e.g. NuvaRing) Patch Emergency contraception (Plan B or similar) Other Have you used hormonal birth control in the past? Yes No If yes, which kinds and for how long? When did you stop? (e.g., pill, IUD, implant, shot, ring) How has your body responded to it (physically, emotionally, or hormonally)? What are your current fertility intentions? Trying to conceive Avoiding pregnancy Transitioning off of hormonal birth control Learning and observing my cycle/body Other Are you currently tracking your cycle in any way? Yes No Only using an app Have you observed any of these types of cervical fluid? (Check all that applies) Dry Sticky/Tacky/Rubbery Creamy/Milky Egg White/Slippery Watery If you're tracking, on average, how long is a full cycle for you? (from the first day of bleeding to the day before your next bleed) Are you familiar with or currently observing any of the following? Basal Body Temperature (BBT) Cervical Fluid Cervical Height, Firmness, Openness Would you like to learn how to observe and chart: BBT Cervical Fluid Cervical Height Cervical Firmness Cervical Openness Do you feel when you ovulate? Yes, I can always tell — my body gives clear signs Sometimes — I think I feel something, but I’m not 100% sure No, I don’t notice anything I’ve never really paid attention before I’m not sure what I should be looking for I’ve had medical suppression (birth control, removal of ovaries, anovulatory cycles, etc.) If you do feel something, what are your signs? Ovulation pain (twinge or cramping, often on one side) Increased libido (feeling more turned on) Egg white cervical fluid (clear, stretchy) Higher energy or mood shift Breast tenderness Slight spotting or pink discharge Other What day of your cycle do you typically suspect ovulation? What do you usually crave in each part of your cycle (or what are you craving now)? How comfortable are you with tracking/observing your cervical fluid? Your body produces cervical fluid throughout your cycle, and its texture and sensation can indicate where you are in your fertile window. This involves noticing discharge on your underwear, when you wipe, or by checking at the vaginal opening. It ranges from dry/sticky to creamy to clear/stretchy like egg whites (the most fertile type). Very comfortable Curious, but unsure Never done it before Nervous or uncomfortable I'd like support learning how How comfortable are you with tracking your basal body temperature (BBT)? BBT is your body’s resting temperature, taken first thing in the morning before getting up or doing anything. It helps identify ovulation after it happens and can show overall cycle health when charted daily using a thermometer or wearable device like Tempdrop. Very comfortable Curious, but unsure Never done it before Nervous or uncomfortable I'd like support learning how How comfortable do you feel about your sexual and reproductive health overall? Very connected Curious but unsure Still learning Would you like to explore your natal lunar fertility? - a theory that suggests we may be fertile when the moon returns to the same phase it was in at your birth. Yes, I'd love to learn more Not right now Do you notice any connection between your menstrual cycle and the moon phases? Yes No I would like to learn more Are you interested in syncing your cycle with the moon’s rhythm for deeper womb connection or fertility awareness? Yes No Maybe Do you have any diagnosed health conditions that affect your cycle or fertility? Not that I know of PCOS Endometriosis Thyroid Imbalance Autoimmune Other Have you had any surgeries, procedures, or injuries related to reproductive health? Yes No Do you experience any of the following? (Check all that apply) Painful periods Irregular or missing periods Heavy bleeding Spotting between periods Pain with sex Recurrent yeast or BV Difficulty conceiving PMS or PMDD Other Your assessment has been submitted. Please text me that you have completed this and I should review it shortly. Thank you!