Guided Fertility

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Pregnancy Intake Form

Your information will be confidential and will only be shared with your consultant.

First Name

Last Name

Date of Birth

Phone

Please Select Topics You Would Like to Cover

Pregnancy Topics

Understanding Early Pregnancy Symptoms (fatigue, nausea, spotting)

Common blood work (tests to expect)

Early Ultrasounds (timing and findings)

Spotting & Cramping (when it's normal vs. when to call your doctor)

First Trimester Nutrition (key nutrients, managing nausea, foods to avoid)

Prenatal Supplements (choosing the right prenatal vitamins and additional supplements)

Lifestyle Adjustments (exercise, sleep, stress management)

Medications & Safety (understanding pregnancy categories)

Morning Sickness Management (natural remedies)

Risks & Red Flags

When to Contact Your Provider (symptoms that require urgent attention)

First Prenatal Appointment (what tests to expect)

Emotional & Mental Well-Being (managing anxiety)

Travel Considerations (safety tips)

Partner & Family Involvement (how to include loved ones in the experience)

What trimester are you in?

Please list questions or concens

Once you hit submit you can schedule your consult

Guided Fertility™ provides education, health promotion, and emotional support. We do not diagnose, treat, or prescribe.

Please follow your physician’s medical advice.

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