Matilda Feedback Circle

Thank you for your interest in joining the Matilda Feedback Circle!
We’re inviting 10 people preparing for or recovering from laparoscopic surgery (for confirmed or suspected endometriosis).

Please complete the form below so we can confirm your eligibility and get you started.

First Name *

Last Name *

Email Address *

Surgeon Name *

Surgery Date *

What is your main reason for wanting to join the Matilda Feedback Circle? *

Your Commitment

To be part of the Feedback Circle, you’ll need to:
✅ Complete the 8-week Matilda digital program (you’ll get full 12-month access), including the outcome measures at onboarding, pre-surgery, and four weeks post-surgery.
✅ Take part in three short 15-minute feedback interviews (by phone or video)
✅ Complete one short post-program survey

Once those are complete, we’ll refund your full $249 payment.

Yes, I understand the conditions and agree to take part. *

Consent & Privacy

By submitting this form, you:

Consent to being contacted by Matilda Health for scheduling interviews and providing program support.
Understand that your responses will help improve the Matilda program and may be used in de-identified reports or presentations.
Agree to the Matilda Health Privacy Policy

I consent to Matilda Health collecting and using my information for research and program improvement. *

After submitting, you’ll be redirected to our Stripe payment page to confirm your place