Client Inquiry Form
In order to provide the best quality care for our clients we offer limited spots in our 1:1 programs. This allows us to provide support and achieve results for our clients.

Please fill out the application form below  so I can get to know you and understand how I can best serve you inside one of my programs. From there if you are good fit for one of my programs  you will be emailed and offered a complimentary 15 minute discovery call.

Don't forget to check your junk or spam mail as my emails often end up in there.

Přihlaste se do Googlu, abyste mohli uložit dosavadní postup. Další informace
E‑mail *
Full Name *
Location *
Please enter alternative contact details in case we cannot contact you via email. (e.g. mobile number) *
How did you hear about Her Exercise Physiology? *
What problem do you currently have that you would like us to help you with? *
What is your dream outcome if you were to work with us inside our 1:1 program? *
How important is achieving this outcome to you? *
Not very
Extremely
Are you ready and willing to commit both physically and financially to a 12 week program? *
Do you have any reservations when it comes to investing in your pelvic health with us? *
Is there anything else you would like to add to your application that might be important for us to know?
I acknowledge that if I am offered a complimentary Discovery Call, this is a time slot allocated to me and if I cannot make this I will let you know in advance (48 hours is ideal) so that the time slot can reopen for those on the waitlist. Should you fail to provide adequate notice or not show up you may lose the right to any future calls or services at our discretion.
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