Fertility Challenges Support Tool Startpress Enter Please complete if you are undergoing fertility investigations and/or treatment Are you (or your partner) attending hospital appointments for Fertility treatment? * Yes No Are you experiencing side effects of your treatment that are interfering with work? * Yes No Will you be required to take medication at a specific time each day and will this require an adjustment at work? * Yes No Is your treatment affecting your ability to work? * Yes No Low mood, mood swings, irritability, anger, crying spells, nervous tension/anxious, social withdrawal? * Yes No Poor concentration, confusion, memory problems, clumsiness * Yes No Difficulty falling asleep and/or staying asleep * Yes No Feeling bad about yourself, guilt, and/or that you have let yourself or your family down * Yes No Thoughts that you would be better off dead or of hurting yourself in some way * Yes No I would like additional support from my employer regarding my pregnancy loss and what I feel comfortable sharing * Yes No Submit If you are human, leave this field blank. ContinueSubmit Use Shift+Tab to go back