Professional Directory Registration Form

Start your registration process.

Fill out the form below to add your listing to the directory.

INFORMATION

Listing Title

Your Full Name

Website URL

Professional / Public Phone

Professional / Public FAX

Professional / Public Email

Enter correct email address

Professional Role

Brands

Specialities

Public Address Location

Street

City

State

Postal Code

Country

Additional Data

Other Credentials

Company or Practice Name

Practice Description

Other Specialties

Personal Phone (Not published! Office Use Only – this is how FACTS will contact you.)

Personal Email (Not published! Office Use Only – this is how FACTS will contact you.)

Do you offer in person services or classes?

Do you offer online services or online classes? (Not telehealth)

Please list the FABMs you have trained in or extensively studied:

Please indicate which FABMs you are formally trained in and/or certified to offer. (Check all that apply)

Do you offer telehealth or telemedicine services?

Do you offer telehealth services?

If yes, please indicate which states you are licensed to practice telemedicine

Please indicate in which languages you provide services?

Do any fertility awareness educators work with you in your practice?

Do you refer to specific fertility awareness educators?

Are you interested in being a FACTS clinical preceptor or case study leader?

Are you interested in being a FACTS Professional or Associate Member? (select one)

Do you have a calendar for people to make an appointment? Put link here to add a Schedule an Appointment button to your listing.

If you wish to list additional educators, please add their name, email address and methods trained in

Please specify the fertility awareness educator to whom you refer

Do you receive our FACTS blogs or newsletter that comes out on Mondays or Thursdays?

Trained/Certified Comments

For privacy reasons, do you want the street address shown on the website?

Additional Areas of Expertise

Do you work with any other FABM trained clinicians or educators in your practice?

If yes, please provide their name and email address, so we may invite them to join the directory.

Additional Description

I agree to and affirm that my services are aligned with FACTS about Fertility principles.

Please agree to register for business in the listing.

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Professional Directory Registration Form

Start your registration process.

INFORMATION

Public Address Location

Additional Data

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