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Living in Luteal Group Program Application

Thank you for your interest in joining the Living in Luteal PMDD Group Healing Program. This is a 4-month program with recorded weekly Zoom calls and sessions. This application helps us assess where you are on your healing journey and ensures this group experience aligns with your goals. This is a waitlist-only program, and spots are limited. Please complete the following questions with honesty and intention.

Click the button below to start.

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Question 1 of 10

1. How is PMDD currently impacting your life?

(Select all that apply)
A

My relationships (with partner, family, or friends)

B

My career, work performance, or productivity

C

My mental health (depression, anxiety, or rage)

D

My physical health (fatigue, body pain, or other symptoms)

E

My self-worth, confidence, and identity

F

Other

Question 2 of 10

2. If you chose “other” in the previous question, please specify how PMDD is currently impacting your life. 

If you did not choose “other”, please type ‘n/a’ below.

Question 3 of 10

3. What have you already tried to manage your PMDD symptoms?

(Select all that apply)
A

Medication (SSRIs, birth control, etc.)

B

Supplements or diet changes

C

Therapy or counseling

D

Other

Question 4 of 10

4. If you chose “other” in the previous question, please specify how you’ve already tried to manage your symptoms.

If you did not choose “other”, please type ‘n/a’ below.

Question 5 of 10

5. What changes do you most desire to experience through this program?

Question 6 of 10

6. Why do you feel this is the right time for you to join a group healing program?

Question 7 of 10

7. Are you ready to invest in your healing journey?

The Living in Luteal Group Program investment is $2,222. Choose the payment plan option below for more information. Some insurance providers cover hypnotherapy, and an invoice will be provided for you to submit for reimbursement.

(Select all that apply)
A

Yes, I’m ready and prepared to invest.

B

I am committed to making this investment work.

C

I would like more information on payment plan options.

Question 8 of 10

8. What would your life look and feel like if you were free from the burden of PMDD?

Question 9 of 10

9. How committed are you to showing up fully and participating actively in this group?

 

(1 = Not ready, 5 = Fully committed)

A

1

B

2

C

3

D

4

E

5

Question 10 of 10

10. Is there anything else you'd like us to know?

Confirm and Submit