Please enable JavaScript in your browser to complete this form.CLIENT INTAKE APPLICATION FORM [30 MINUTES] ***Please set aside 30 minutes to work through this Client Intake Application Form. Spaces are limited and this intake form is not a guarantee that you will be selected to join the current cohort. Course intakes occur multiple times throughout the year; if your application is not accepted due to space limitations, Jessie will contact you to see if you are still interested at the next intake.***The Natural Contraception Online Course is not suitable for minors: *I confirm I am 21 years or older on the day I sign this formAge *Postal Address [number, street, suburb, state, postcode, country] *Medical clearance *I confirm that I have spoken with a licensed physician and cleared my plans to learn the Symptothermal Method for pregnancy prevention.Occupation *[tick all] I understand that learning the Symptothermal Method will require: *Hard work, determination, motivation and a curious can-do mindset.Collaboration and open sharing with a group of other peopleA positive, friendly and respectful attitudeA reliable internet connection (minimum 1.5Mbps) to support online group learning environmentTaking radical responsibility for my learning journey. Nobody else can learn on my behalf. Jessie will be here to guide you and support you on your journey, but for you to get the most benefit you will need to approach this course with a positive can-do attitude. Learning is HARD work! It's not easy. It requires consistency, dedication and determination. It also requires a curious mind. This course is a group learning program and involves sharing and learning collaboratively. You will need to be comfortable with this to join. If you think you will struggle with any of the above, then this course is not for you.This course is taught in Celsius. Example charts and course materials are in Celsius. Rules are also provided in Fahrenheit; however, you will only have Celsius course materials and chart examples to refer to. This may make it more difficult to learn the method if you would prefer to use Fahrenheit: *Yes, I understand and am comfortable with this and will use CelsiusYes, I understand and am comfortable with this but I will choose to use Fahrenheit. I understand that there are no Fahrenheit chart examples.I confirm that I am NOT currently trying to conceive. I am interested in learning the Symptothermal Method for *contraceptionhealth trackingboth of the aboveIf you are interested in learning the Symptothermal Method for conception purposes, please refer to the Chart To Conceive online self-paced course.[tick all] I recognise and acknowledge the following limitations: *I recognise and acknowledge that the only 100% effective contraception is complete abstinence; all other types of contraception will always carry a varying degree of risk of pregnancy.I recognise and acknowledge that the Symptothermal Method, like all other forms of contraception, is not 100% effective.I recognise and acknowledge that the effectiveness of the method will largely depend on my understanding of the rules, and my ability to modify my sexual behaviour during the fertile time. I recognise and acknowledge that the use of barrier methods and/or withdrawal during the fertile window means that I am relying on the effectiveness of the barrier method, not the Symptothermal Method.[tick all] I recognise and acknowledge the following limitations of contraceptive effectiveness estimates: *I recognise and acknowledge that with "perfect use", some Symptothermal Methods have been shown to be up to 99.6% effective when learned with a qualified instructor of a Symptothermal Double-Check MethodI recognise and acknowledge that "typical use" effectiveness rates are less clear. Some clinical trials have shown that the Symptothermal Method may be up to 98.2% effective with typical use; however, it's unlikely that the sterile conditions of a clinical trial are reflective of real-world scenariosI recognise and acknowledge that these current effectiveness estimates may change in future as more high quality studies are carried outI recognise and acknowledge that these effectiveness estimates are based on "in-person" instruction with specific course materials of the specific Sensiplan method. The Natural Contraception Online Course is taught online, with independently-created course materials, and therefore a 99.6% perfect-use effectiveness cannot be and is not guaranteed.[tick all] Jessie is certified via the Natural Family Planning Teachers’ Association of the United Kingdom (NFPTA-UK), which is the organisation that Sensiplan originally branched off of. The method taught in the Natural Contraception Online Course is NOT 'pure' NFPTA. Instead, it is an independently provided Symptothermal Double-Check Method.I recognise and acknowledge that while Jessie is certified via NFPTA-UK, she does not teach ‘pure’ NFPTA-UK charting. I recognise and acknowledge that while all changes are supported by existing Symptothermal Double-Check Method research, method effectiveness cannot be guaranteed and the Natural Contraception Online Course is provided independent of NFPTA-UK oversight.Key instances where this course differs from pure NFPTA include but are not limited to: >>>>>>>>>>Calculation rules>>> NFPTA-UK utilises a First Five Day Rule, an S-21 Rule and an S-20 Rule (and unofficially offers a Minus-8 Rule styled on Döering’s research and protocols). These are incrementally offered as users move through phases (first three cycles, cycles 4-6, cycles 7-12, and cycles 13 and onward). Jessie believes the calculation rules offered through NFPTA-UK are overly convoluted and can work to confuse users. Instead, Jessie offers simplified conservative calculation rules closer to those of the Sensiplan protocol. Jessie follows NFPTA-UK protocol and recommends reserving unprotected sex to Phase 3 only during the first three menstrual cycles of learning. From the 4th menstrual cycle onward, users may choose from the First Five Day Rule or the S-20 Rule (pending certain important conditions are met). From the 13th menstrual cycle onward, users may apply the Minus 8 Rule (pending certain important conditions are met). The calculation rules taught by Jessie are based on historical Symptothermal Method protocols backed by modern research.>>>>>>>>>>Basal body temperature>>> NFPTA-UK allows for adjustments of temperatures taken at different times of the morning. Jessie does not teach or support this practice as she believes it can encourage BBT inaccuracies. NFPTA-UK does not provide an exception rule to cover fallback rises; Jessie teaches a Fallback Rise rule in accordance with historical Symptothermal Method protocols and this approach is backed by modern research on temperature monitoring. NFPTA-UK provides charts in a temperature scale of 0.05°C and require temperatures to be plotted between lines. NFPTA-UK employ a visually raised coverline and and do not provide a rounding guide for temperatures. Jessie provides charts in a temperature scale of 0.1°C/0.2°F and temperatures can be plotted both between and on the lines. Jessie teaches a coverline that is placed on the highest of the six lows and is not visually raised. Jessie provides a rounding guide for temperatures to be rounded to the nearest 0.05°C/0.1°F as per historical research and guidelines for BBT charting. >>>>>>>>>>Cervical mucus>>> NFPTA-UK have a cervical mucus classification system of three tiers (any mucus seen, wet/stretchy, clear/slippery). Jessie does not teach these cervical mucus categories. Instead, Jessie teaches students how to record (in their own words) the visual characteristics of their cervical mucus, in addition to sensations at the vulva. Users then summarise these observations into a simple three-tier category of Dry, Non-Peak and Peak type observations. This classification system (Dry, Non-Peak and Peak) is based on historical Symptothermal Method protocols and backed by modern research. It is best suited to users in times of regular fertility and is less suited to those relying primarily on cervical mucus only in the postpartum and perimenopause.This course is most suited to people who get their period *I confirm that I have a menstrual cycle and I do get my period If your period has "disappeared" due to overexercising, undereating or stress this course is not appropriate for you. Please reach out as I can point you toward resources if you are struggling to regain your period due to Hypothalamic Amenorrhea.This course is most suited to people who are in times of normal fertility *I confirm that I am not currently perimenopausal/menopausalI confirm that I am not currently in the immediate postpartum (if you have recently given birth, your menstrual cycle must have returned and you must have experienced at least 3 or more bleeds from day 56 after birth onward to be eligible to join the Natural Contraception Online Course).I confirm that I AM currently in the immediate postpartum but have made the informed decision that I would like to go ahead and learn the Symptothermal Method in preparation for when my menstrual cycle returns.IMPORTANT: If you have recently given birth, and are awaiting the return of your fertility, I recommend that you seek out instruction from a Billings Ovulation Method (BOM) Instructor as opposed to taking this course. The BOM is a cervical mucus only method. The BOM may reduce the need for long periods of abstinence, and allow you to make use of more days for unprotected sex while you await your first postpartum ovulation. Similar applies if you are currently perimenopausal. Please feel free to email me for a referral to a BOM instructor as you navigate these special circumstances of fertility. Alternatively, you are welcome to make the informed decision to go ahead and join the Natural Contraception online course to learn the Symptothermal Method.How would you describe your menstrual cycle? *Regular cyclesLong cyclesVery long cyclesYou should be aware that if you have very long cycles, this will result in longer periods of time where abstinence or alternative barrier methods of contraception are required. The Symptothermal Method itself is still highly effective and able to confirm that ovulation is occurring; however, extended periods of time using barrier methods of contraception (such as condoms) can be frustrating for some users. Extended periods of time using barrier methods of contraception such as condoms may also reduce the effectiveness of the method (as you are relying for longer periods of time on the lower effectiveness of barrier methods). IMPORTANT: If your cycle is very long (for example if you have PCOS and consistently have menstrual cycles that are over 50 days long), I recommend that you seek out instruction from a Billings Ovulation Method (BOM) Instructor as opposed to taking this course. The BOM is a cervical mucus only method. The BOM may reduce the need for long periods of abstinence, and allow you to make use of more days for unprotected sex. Please feel free to email me for a referral to a BOM instructor (or alternatively you can also make the informed decision to go ahead and sign up for the Natural Contraception Online Course).Do you have a relatively consistent waking time most days, with 1-3 consecutive hours of sleep prior? *UsuallyNot usuallyIf you answered "not usually", you should be aware that you may need to change your routine slightly to use the Symptothermal Method. If it is not possible to change your routine, there are other ways to work around this issue; however, you should be aware that this may require a financial outlay for a Tempdrop device. Alternatively, it may require that we use different methods of temperature-taking that will take up more of your time. If you want more information about this before investing in this course, please reach out to speak with Jessie.Do you drink alcohol? *NeverRarelySometimesOftenVery oftenIf you frequently drink alcohol, you should be aware that this can impact the accuracy of your basal body temperatures. A glass here and there of red wine with dinner is not usually an issue; however, any more than this may have an impact. Sometimes, it is necessary to avoid nights of drinking during times of your cycle where it is important to obtain an accurate BBT (such as around the time of ovulation). Sometimes, using the Symptothermal Method may require a lifestyle change toward less drinking. It's important that you are aware of this before investing your time and money into learning the Symptothermal Method.Have you ever taken hormonal birth control? *YesNoIf you have ever taken hormonal birth control, please specify which type:If you have ever taken hormonal birth control, please specify the most recent date of discontinuation of your last taken hormonal birth control:If you have ever taken hormonal birth control, was it required for medical reasons other than contraception? If yes, please specify:Do you experience irregular bleeding during your cycle? *YesNoNot sureIf you indicate yes, please organise to check in with your healthcare provider for a pap smear test (if you haven't recently done so). This is especially important if you experience bleeding after sex. Please be aware that if your charts indicate non-menstrual bleeding/spotting, Jessie will ask if/when you have recently had a pap smear.Are you currently on any medications? *YesNoIf you are currently taking any medication, please specify below if you are comfortable doing so:If you were NOT on hormonal contraception during the last 12 menstrual cycles - do you have an accurate written record of the lengths of those cycles? *Yes, I have an accurate record of my last 12 natural menstrual cycles (either written in a journal or recorded in an app)No, I do not have a record of my last 12 natural menstrual cyclesI was on hormonal contraception so I was not having natural menstrual cyclesIf you answered YES to the above and you do have an accurate written record of the lengths of your last 12 natural menstrual cycles, please record the length of the shortest cycle you experienced below. The first day of your menstrual cycle begins on the first day of your period where you experience fresh red bleeding (spotting does not count). Your menstrual cycle lasts until the day before your next period. It's very important that the answer to this question is based on accurate information about your cycle lengths.Are you comfortable using coitus-dependent contraceptives?No, I am morally or religiously opposed to the use of coitus-dependent contraceptives. Abstinence will be used instead.No, I do not want to use coitus-dependent contraceptives (but this is not because of moral or religious reasons). Abstinence will be used instead.Yes, I am comfortable using some/all types of coitus-dependent contraceptives, some/all of the time.The term 'coitus-dependent contraceptive' refers to any type of method that must be used consistently during every sexual encounter. Coitus-dependent contraceptives include: Coitus interruptus (sometimes known as the “withdrawal method” or the “pullout method”), condoms (both internal and external), diaphragms, cervical caps, contraceptive sponges and spermicides. Week 6 content includes detailed modules on coitus-dependent contraceptives. Do you have any other relevant comments or gynaecological issues you would like to mention? If so, please record them here: [tick all] During the course, you will be sharing your charts with Jessie during 1:1 consultations. These charts remain private and confidential. Jessie occasionally works with professional mentors and also networks with a range of other experienced instructors around the world. Jessie may share your charts with a professional mentor or experienced peer instructor for a second opinion for any situations that would benefit from a second pair of experienced eyes:I understand and agree that the charts that I share with Jessie may also be shared with a professional mentor or experienced peer instructor.I understand that if this is the case, all identifying features will be removed from my chart so that my data remains anonymous.I understand that my data belongs to me, and I can request that it be returned or destroyed at any stage during or after the Natural Contraception online group program has ended.Have you learned about the Symptothermal Method anywhere else previously? *No, I've never learned about the Symptothermal MethodYes, I have read a book on the method (for example, Taking Charge of Your Fertility)Yes, I have worked with another instructorYes, otherIf you have learned about the Symptothermal Method previously, please give a brief overview here of how you learned:On a scale of 1 to 10, what number would best describe your current knowledge of the Symptothermal Method? *1 = no knowledge at all -----> 10 = a competent, knowledgeable charterPlease share briefly why you are interested in signing up for this program. What has inspired you to search for more information about using the Symptothermal Method?Are you a follower of the Fertility Charting Instagram page? If so, please type your Instagram handle below: *1:1 consultations / Jessie's office hours *I recognise and acknowledge that Jessie's office hours are Wednesdays and Saturdays (with occasional Thursdays)I confirm that I will be able to book my 1:1 consultations on these days.I recognise and acknowledge that my 1:1 consultations are spread out with a limit of 1 per calendar month across each three/six month program.Refunds: After the first two weeks, the Natural Contraception Online Course fee is non-refundable: *I recognise and acknowledge that should I have a change of mind and require a refund for any reason, I can action this during the first two weeks of this course.I recognise and acknowledge that after the first two weeks, no refunds will be provided for any reason at any point during the Natural Contraception Online Course.I recognise and acknowledge that my refund will not include the AU $120 cost of the course handbook, nor the postage required to send it to me.If you are undertaking 1:1 individual coaching, please advise which package you prefer: *I wish to purchase the three month 1:1 individual coaching packageI wish to purchase the six month 1:1 individual coaching packageNot relevant / I am filling out this form for a group coaching intakePayment Plan Option *I need a payment planI do not need a payment planAn extended payment plan is available for those who require it. The course fee is split across four equal payments during the first four months. The first of these four payments is required before course access is granted.If you require a payment plan:I recognise and acknowledge that if a monthly payment fails or is late, I immediately lose access to the course material and to Jessie's support via WhatsApp. Failed payments will be automatically retried every 24 hours until they are successful. Copyright Protection: The Natural Contraception Online Course (and associated course handbook) is published by Fertility Charting, Tugun QLD, 4224, AUSTRALIA. https://fertilitycharting.com.au ©2019-2021 Jessie Brebner. The content (written, visual and audio) of the Natural Contraception Online Course (and associated User Manual) is protected under Australian copyright law. No portion of the written, audio or visual content of the Natural Contraception Online Course (and associated User Manual) may be reproduced or shared in any form, without express permission from the Publisher, except as permitted by Australian copyright law. For permissions, contact support@fertilitycharting.com.au. *I will not COPY, REPRODUCE, PLAGIARISE or SHARE the content or any part of the content (whether written, visual or audio) of the Natural Contraception Online Course (and associated User Manual) in any form whether digital or hardcopy.I recognise and acknowledge that my user login details are confidential. I will not share my username or password with anyone for any reason.Personal Use Only *I understand and agree that the Natural Contraception Online Course is for personal use only. I will not use the knowledge or resources gained within the Natural Contraception Online Course to commercially teach others how to use the Symptothermal Method.If you are a Naturopath, Herbalist, Acupuncturist, Traditional Chinese Medicine Practitioner, Yoga teacher, Health Coach, Wellness Coach, Nurse, General Practitioner, Obstetrician Gynaecologist or any other allied, alternative or medical health professional who wishes to teach patients and clients how to use the Symptothermal Method for pregnancy prevention, conception or hormonal health-tracking, you will need to obtain a certification through an accredited teacher training provider (such as NFPTA-UK, SymptoPro, Sensiplan, Couple to Couple League, Natural Fertility New Zealand, Justisse, The WELL, Billings Ovulation Method, Creighton, or FEMM). It is recommended to chart your cycles with your chosen FABM for at least one year before embarking on a teacher training course.Liability release and waiver:I understand that if my application is successful, I will be required to sign a liability release and waiver form, based on the information relayed to me within this Client Intake Application Form.Date *Name *FirstLastEmail *SignatureClear SignatureThanks again for taking the time to apply to learn with Jessie - stay tuned to hear more within the next 7 days.MessageApply For Intake Now