Fertility Readiness Assessment Form
Evaluate your general fertility readiness with this non-diagnostic self-assessment. Your responses are private and for personal reflection only.
How would you rate your overall physical health?
*
1
2
3
4
5
How often do you engage in regular physical activity (e.g., exercise, sports, walking)?
*
Daily
Several times a week
Once a week
Rarely
Never
How would you describe your current nutrition and eating habits?
*
Very healthy and balanced
Somewhat healthy
Average
Needs improvement
How would you rate your current stress levels?
*
Very low
1
2
3
4
Very high
5
1 is Very low, 5 is Very high
On average, how many hours of sleep do you get per night?
*
7-9 hours
6-7 hours
5-6 hours
Less than 5 hours
How familiar are you with factors that can affect fertility (e.g., age, lifestyle, health conditions)?
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Not familiar
1
2
3
4
Very familiar
5
1 is Not familiar, 5 is Very familiar
Do you have a regular support system (partner, friends, family) to discuss your fertility goals?
*
Yes, always
Sometimes
Rarely
No
How confident do you feel about your current readiness to pursue fertility-related goals?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Which of the following best describes your current fertility-related goals?
*
Actively trying to conceive
Planning to try in the next year
Considering options for the future
Not sure yet
Please rate your comfort with seeking professional guidance or resources about fertility if needed.
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
Submit Assessment
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