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Let's start with the basics
Email Address *
Age Group *
Select Age
Under 18
18-24
25-34
35-44
45+
Where are you from? (City & State) *
What do you do? *
Student
Working
Homemaker
Self-employed
Other
Preferred language for health content? *
English
Hindi
Regional Language
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Your Experience
Have you faced any of these in the past year? (Pick all that apply)
Severe cramps
Irregular cycles
PCOS/Hormonal
Mood swings/PMS
Heavy bleeding
No issues
How often do period problems affect your daily life? *
Every month
Sometimes
Rarely
Never
Have you ever had medical tests or scans related to periods? *
Yes
No
I was told to, but didn't
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Medical Habits
When you have an issue, what do you do first? *
Google it
Ask family/friends
Take medicine at home
Visit a doctor
Ignore it
How often do you consult a gynecologist? *
Regularly
Only when it's serious
Rarely
Never
What makes doctor visits difficult? (Select all)
Too expensive
No clinic
Embarrassment
Time issues
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Digital & Trust
Ever used a mobile app or website for women's health? *
Yes, often
Sometimes
No, but I would try
Not interested
Which sources do you trust? (Pick all)
YouTube
Google articles
Friends/family
Doctors
Instagram Pages
Would you prefer a doctor from your region/language? *
Yes, definitely
Doesn't matter
No
Back
Continue
Final Steps
What's the biggest challenge women face around periods? *
Top 3 things that would make health easier? (Pick 3)
Affordable doctor
Trusted guidance
Fits my symptoms
Friendly videos
Anonymous chat
Natural tips
Join women-led wellness circles in the future? *
Yes
No
Maybe later
Any other thoughts, feelings or comments? *
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