Name *

First Name

Last Name

1. Do you track your menstrual cycle? *

Yes

No

2. Have you had your period in the last 1-2 months? *

Yes

No

3. Which method of birth control do you use? *

Oral contraceptive (the pill)

IUD-hormonal

IUD-copper

None

4. Do you understand the different hormones of the menstrual cycle and the effect they have on your body? *

Yes

No