Apply for your free Fertility Accelerator Call With Dr. Nashat

This call is the key to uncovering the factors that may be keeping you from getting pregnant and developing a plan tailored to you.

The 4R Fertility Formula™ Call Booking Form

This short form helps us to understand your fertility history so we can help you move forward faster on our call. It will take around 3 minutes to complete.

NOTE:

Please provide your FULL NAME, as well as DETAILED, meaningful answers to your questions so we can make the most of our time together. Incomplete or short answers to questions may require your call to be cancelled. If you CANNOT find a time that works well for you, please send us an email at [email protected], we will do our best to find at time that suits you! Thank you.

How old are you? *

Less than 25 years old

25-30 years old

30-35 years old

35-40 years old

40-45 years old

Greater than 45 years old

How old is your partner? *

Less than 25 years old

25-30 years old

30-35 years old

35-40 years old

40-45 years old

Greater than 45 years old

No partner or using donor

Will your partner be present for our call? (Mandatory) *

Yes

No

I don't have a partner

Please choose a time that both you and your partner can be fully present for the call.

Please tell us your partner's full name

What treatments, medications or procedures have you tried in the past? *

What is important to you about solving your struggle with infertility? *

On a scale of 1-10, 1 being NOT committed, 10 being FULLY committed, how committed are you to doing whatever it takes to solve this problem now and conceive a baby naturally? *

1

2

3

4

5

6

7

8

9

10

How much would you be willing to invest in a 12-week solution that will have you ready to get pregnant naturally? *

I'll invest what I need as long as it works for me

$4000 - $6000 - As much as a nice vacation

$6000 - $8000 - As much as a bathroom upgrade

I don't have the finances now, but maybe later

Your response doesn't change our pricing. It helps us determine support options available within your budget. **Please note that we have payment plans available**

Which of the following best describes your current situation? *

I am currently in the middle of an IUI cycle

I am currently in the middle of an IVF cycle

I plan to start IUI or IVF within the next 4-8 weeks

I have failed IUI/IVF and am currently taking a break

I have no interest IUI or IVF and want to get pregnant naturally

Where do you live? *

United States

United States Military Base

Is there any reason you would NOT be ready to get started right away in a 12-week program that could have you ready for a natural pregnancy?

(If the answer is yes, please provide additional details so we can best support you.)

First Name *

Last Name *

Email *

Phone *

How did you hear about us?

Select option

Facebook Ad
Instagram
Google Search
Dominique Sachse - YouTube
Kristen and Michael Maughan
Other - Referral
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