Before we meet

This is an invitation to reflect, not a checklist to complete. There are no wrong answers — only your experience, in your own words.

~8–10 minutes · saved as you go · read only by me

✦

With care, Juan Carlos

Welcome back — your answers are saved.

You 1 of 7

First name

Please enter your first name.

Email address

Please enter a valid email address (e.g. name@example.com).

What brings you here 2 of 7

What is the primary reason you are seeking care at this time?

Describe it however feels most true — physical, emotional, or both.

How long has this been present, and what — if anything — have you tried?

Where you are in care 3 of 7

Where are you in fertility care right now?

Select all that apply

Any diagnoses, suspected or confirmed?

Select all that apply

What are you currently taking? (if anything)

Medications, hormonal treatments (letrozole, gonadotropins, etc.), supplements.

Any previous pregnancies, losses, or fertility treatments?

You can skip this and tell me in person if you'd prefer.

The cycle 4 of 7

Describe your menstrual cycle in as much detail as you can.

Length, regularity, pain (when, where, what quality), spotting, how it has changed over the years. Every detail is clinically meaningful.

How do you feel in the days before your period begins?

Select all that apply

Flow: how would you describe the color and texture?

Select all that apply

Body & rhythm 5 of 7

Do you tend to run warm or cold?

How is your appetite and digestion?

Select all that apply

When does your energy feel most alive?

Select all that apply

How is your sleep?

Select all that apply

Inner landscape 6 of 7

What depletes you fastest — and what actually restores you?

Both halves matter equally. Not what should restore you — what actually does.

Birth data & closing 7 of 7

I use your birth information to build a picture of your constitutional energetic tendencies — your baseline, and what your body is naturally inclined toward. Approximate time is fine if exact is unknown.

Date of birth

/ /

Time

Place

In your own words, what would it mean to you to be supported in this process?

Is there anything else you'd like me to know that I haven't asked about? (optional)

Thank you for taking this time with yourself.
I look forward to continuing this conversation together.

Your responses are sent privately to me. I store them securely and read them only in preparation for our session. They are never shared, sold, or used for any purpose outside our work together.

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Received

Your words have arrived safely.

I'll carry this into our first conversation.

With care, Juan Carlos