Fertility Questionnaire

Fertility Questionnaire

Conception and Menstrual History

Have you been pregnant before?
Do you have a history of miscarriage?
Do you have any diagnosed gynaecological conditions (including fibroids, endometriosis, PCOS, PCO, progesterone deficiency or estrogen dominance, low egg quality, low AMH, thin uterine lining, ovarian cysts)?
Do you keep a Basal Body Temperature Chart?
If yes, please email your 2 most recent charts or bring them to your appointment.
Do you test for ovulation (ovulation kits or Maybe Baby)?
If you do test, do you receive a positive result (the test line MUST be darker than the control or obvious ferning with a Maybe Baby)?
Do you have a regular cycle?
Please tick any of the following that you commonly experience in relation to menstruation:

Assisted Reproduction

General Health

Do you regularly work more than an 8hr day?
Would you consider your job generally stressful?
Do you feel you get ‘sick’ (colds, flus,etc) more often than normal?
Please select one option for each of the following.
Please confirm this form has successfully submitted before exiting the page. If the form did not submit there may be errors in the form indicated in red.
Make an online booking here:
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Valued at $120, your Assessment will help to uncover:

  • What is going on with your body
  • What is working properly and what is not working properly
  • What is causing the problem, and
  • The best way to get it sorted out

All this will be fully explained to you, and you can ask as many questions as you like. That way we can be sure to give you all of the right information, understanding and advice you need. Terms and conditions: This is a free, no obligation offer.


62 Looranah St,
Jindalee QLD 4074
07 3376 6911


Winner Business Achievers Award 2006, 2007, 2009, 2011 & 2012
Inducted into Business Achievers Hall of Fame 2009
LPA Outstanding High Achievement Award 2011
Mt Ommaney Small Business Award (Health & Fitness) 2018 & 2020
Mt Ommaney Small Business Community Spirit Award 2021


We help provide care and accommodation to young disabled people through regular support of YoungCare (by donating the proceeds of our Gift Voucher sales)

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