Cycle Wise Application Form

This online course offers in-depth education on body literacy through cycle tracking. You’ll learn about the four phases of your menstrual cycle, key hormones, and how hormonal health influences your overall well-being, including mental health and energy levels. The course covers natural approaches to menstrual health, cycle charting, urinary hormone tracking, and common menstrual conditions like PMS, PCOS, and endometriosis. You’ll also explore family planning methods, including natural birth control and fertility awareness, with a balanced look at the benefits and risks of different approaches. The course is self-paced, allowing you to learn on your own schedule. At the end, you can opt to receive a free basal body temperature thermometer to help you start your cycle tracking journey.
Contact Information
Name*
First Last
Email*
Your Date of Birth*
MM slash DD slash YYYY
Age*
Address*
Street Address Address Line 2 City State ZIP Code
Primary Phone*
Alternate Phone
Check if it is okay to leave a message on your phone(s):
- Yes, on my primary phone
- Yes, on my alternate phone
Check if it is okay to text you:
- Yes, on my primary phone
- Yes, on my alternate phone
Help us get to know you better so we can best serve your needs...
Marital Satus:
- Married
- Separated
- Divorced
- Single
- Living Together
- Widowed
Concerns
What are your primary concerns regarding cycle tracking or body literacy?
Program Goals
Program Goals*
Please tell us what you hope to gain through participation in the Cycle Wise program. Please also note specific goals you desire to achieve and any special topics you would like to learn about in regards to body literacy and cycle tracking.
Agreement
I agree that I will be solely responsible for inspecting and determining the fitness and safety of any material items I receive in connection with the Cycle Wise program. I agree to hold harmless the WCPC and/or any of its employees and agents with respect to any and all claims of whatever nature arising out of my participation in the Cycle Wise program and/or my receipt of any items in connection with such program. I understand that at any time my participation in the Cycle Wise program may be revoked as deemed appropriate by clinic staff. I have read and understood the above information.
The Whatcom County Pregnancy Clinic (WCPC) is a faith-based, nonprofit organization. All of our services are free to the client regardless of age, sex, race, income, nationality, religion, disability, marital status, or other arbitrary circumstances. We offer pregnancy tests with ultrasound when medically indicated, educational information, resource information, and access to the Baby and Me Shoppe through the Earn While You Learn program.
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Cycle Wise Application Form

Contact Information

Help us get to know you better so we can best serve your needs...

Program Goals

Agreement