This questionnaire will help determine if one-on-one coaching with me can help you achieve your fertility and wellness goals.

Once you complete the questionnaire, you will then be prompted to schedule a 20-minute consultation. During this call, we will have a powerful conversation to find out what’s really holding you back from feeling more energized and nourished in your womb and in your life. It’s also a chance to see if working together, with me as your fertility health coach, will help you create the lasting change you’ve been craving and to make sure we’re the perfect fit.

Please keep in mind, these complimentary sessions are limited in availability and are reserved for women who are genuinely interested in exploring working together at this time. Since I deeply respect your time, and my own, please only complete the following application if you’re genuinely open and willing to create profound, positive changes in your life and are ready to take action now.

Please fully complete the questionnaire below and submit no later than 48 hours prior to consultation call so that I may have time to review.

After you complete the form, you’ll immediately be able to schedule your session with me.


First & Last Name


Phone Number or Skype name if international

Location / Time Zone

How did you learn about me and my programs?

1. What are your frustrations with your womb health?

2. Do you have a diagnosis that affects your fertility? Please describe in detail.

3. What have you tried so far to help improve your womb health? For how long did you try these things? What worked and what didn't work?

4. How do you feel about your job/career? Is your work stressful?

5. Is your partner/spouse working in a stressful environment too? If yes, please explain.

6. Do you or your partner work in an environment where you are exposed to toxins or chemicals?

7. Have you ever worked with a health or fertility coach before? If yes, please explain in detail.

8. What do you hope to achieve from working with Cathyann one-one-one?

9. How important is it (1 being the least, 10 being the most) for you to heal your fertility challenges and/or womb health concerns right now?

10. Where do you rank (1 being the most, 10 being the least) the priority of improving your fertility health, compared to other current goals you might have going on right now: taking care of home, pursuing educational goals, supporting of family or children, etc.?

11. Which one-on-one coaching option are you most interested in discussing during your consultation?

12. If you are a right fit for private coaching with Cathyann, how able or willing are you to invest in your personal health & wellbeing right now?

APPLICATION SUBMISSION AGREEMENT: I’ve completed the Fertile Womb Lifestyle pre-session application and would like to be considered to work with Cathyann Greenidge-Ellison in a coaching relationship. I understand that this application is confidential, and I am only showing interest in the program and am under no obligation to make a payment at the time of submitting this application. If we do decide that I am the right fit for the coaching program of my choice, I am ready to make the financial investment and time commitment of this coaching program a priority.
I Agree