Infinite Fertility™ Application | High-Touch Fertility Support

Apply for Care at Infinite Fertility

This application is for women and couples who are ready for a deeper, more personalized path to conception - one that looks beyond symptoms, protocols, and quick appointments to support the whole body, whole life, and whole woman.

Dr. Surjana works with a limited number of private clients each month. This form helps us understand your story, your goals, and whether this care model is the right fit for where you are in your fertility journey.

Full name

Phone

How long have you been trying to conceive?

Have you worked with a fertility doctor before?

Choose all that apply

What has your fertility journey looked like so far, and what has been your biggest challenge?

Infinite Fertility looks at the full picture - your body, lifestyle, nourishment, nervous system, emotional world, intuition, and capacity to receive. What are you hoping will shift through this work physically, emotionally, spiritually, or practically?

This care model looks at the full picture — your body, lifestyle, nourishment, nervous system, emotional world, intuition, and capacity to receive. Are you open to this level of holistic support?

Yes, this is exactly what I'm looking for

Yes, I'm open and curious

I'm not sure

No, I’m looking for a more conventional/medical-only approach.

What draws you to working specifically with Dr. Surjana and the Infinite Fertility approach?

Infinite Fertility is a premium, private care experience for women and couples ready to invest in high-touch fertility support. Are you prepared to make this level of investment if it feels aligned?