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PCOS Made Manageable Application

Thank you for your interest in PCOS Made Manageable! Complete this application and book a consultation call to see if you qualify..

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Question 1 of 12

Full Name:

Question 2 of 12

Email Address:

Question 3 of 12

Phone Number:

Question 4 of 12

Age:

Question 5 of 12

Where are you on your PCOS journey? (Select the one that feels most true)

A

I was just diagnosed and feel overwhelmed.

B

I’ve known for a while but haven’t found something that works.

C

I’ve tried some things, but I still struggle with symptoms.

D

I feel like I sort of know what to do but need structure and accountability.

E

Other

Question 6 of 12

What are your biggest struggles right now?

(Select all that apply)
A

Irregular or absent periods

B

Acne or skin issues

C

Hair loss

D

Excessive hair growth (hirsutism)

E

Weight gain or difficulty losing weight

F

Fatigue

G

Mood swings or emotional distress

H

Digestive issues (e.g., bloating, constipation)

I

High stress or anxiety

J

Other

Question 7 of 12

What’s feeling hardest for you right now?

Example: "I feel stuck because I don’t know what actually works."

 

Question 8 of 12

How committed are you to making changes?

(Be honest! No judgment – this helps me guide you best.)

A

100% – I’m ready and need a clear plan.

B

I want to be all in, but I need support staying consistent.

C

I know I need to do something, but I’m not sure I’m fully ready.

D

Other

Question 9 of 12

Imagine 4 months from now - what would be a dream outcome for you?

(Let yourself go there! What would change in your life if you felt great?)

Example: “I want regular, pain-free cycles, more energy, and to stop stressing about food.”

Question 10 of 12

Why is NOW the time for you to do this?

(Select all that apply)
A

I’m sick of feeling this way and need real solutions.

B

I’ve wasted enough time trying things that don’t work.

C

I want support and accountability to make this easier.

D

Other

Question 11 of 12

Are you ready to invest in yourself and your health?

A

Yes! I know my health is worth it.

B

I want to, but I have some hesitations.

Question 12 of 12

Is there anything else you’d like me to know? (optional)

(This is your space to share anything that feels important!)

Confirm and Submit