Application to work with us 1:1
This is an application for our 1:1 Pelvic Health + Postnatal Exercise Coaching Program
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To confirm, you are filling out this application because you are interested in learning more about our 1:1 pelvic health & postnatal program for pelvic floor + core birth prep or postpartum recovery  *
Required
Are you currently pregnant or postpartum? *
How many weeks or months  pregnant/postpartum? *
Are you struggling with any pelvic floor dysfunction (leakage, prolapse, diastasis recti, painful S*x) ? If yes, explain more! *
What have you tried up to this point to solve your challenge(s)?
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In your own words, what do you need to solve your challenge(s)?
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Please share a bit about what interests you most in working with Your Postpartum PT + Wellness, specifically? *
If you were to work with us, what are your top 3 goals you want to achieve in the next 3-6 months? *
Where are you at in terms of your timeline of readiness to start the process of your postpartum + pelvic health  recovery ? *if this is a good fit, of course!* *
If we know we can help you tackle your pelvic health concerns + recovery, are you willing to dedicate time & financial resources to tackle these challenges together? **if you need to talk with a partner please make sure you are both on the same page before joining the call** *
Required
Full Name *
Email *
What is your IG account - IE: @yourpostpartumpt is mine, what is yours? *
Phone # *
Mailing address * we ONLY use this if you enter our program to send a welcome gift* *
What's your occupation? Yes, SAHM is an occupation, too ;)  *
Were you referred by anyone specific? Please share their name below if so! *
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