Matilda Waitlist Form

Our existing programs support people undergoing endometriosis-related surgery and hysterectomy, combining multidisciplinary education, preparation and recovery support in one accessible digital program.

We want to hear about the gaps clinicians see every day. If there’s a procedure, condition or patient population that could benefit from better preparation, multidisciplinary education or recovery support, tell us.

Which Matilda program(s) would be most valuable to your practice? Select all that apply. *

Other

Approximately how many patients per month could this program support in your practice? *

1–56–1011–2020+

Would you be interested in being an early partner for this program? *

Yes, I’d be interested in piloting itYes, keep me updatedMaybe, I’d like to learn moreNot at this stage

Anything else you would like to share:

Your Details:

First Name *

Last Name *

Email Address: *

Mobile:

Profession: *