Apply to Work with me Privately

Name*
First Last
Email*
Best Phone or Skype*
What Is Your Occupation?*
What kind of activities does your condition prevent you from doing or enjoying?*
Does your condition impact your ability to work?
- Yes
- No
Type of Pelvic Floor Condition You Are Suffering From? (in Medical terms or Layman's Terms)*
How long have you been suffering with your current condition?*
Do you feel like your condition can improve?
- yes
- no
What do you think caused your condition?*
What is the biggest barrier or barriers you need to overcome in order to achieve your goal?*
What have you tried thus far that has helped relieve your symptoms?*
If you had a magic wand and would be able to cure your pelvic pain, how would your life be transformed?
If you were able to be pain and symptom free in 3 months and live the life you deserve, what would you be willing to invest?*
- $2000 - $4000
- $5000 - $8000
- $8000 - $15,000
- $15,000 - $20,000
How would you describe your budget as it relates to investing in your healing?*
- Tight Budget: My budget is tight and I want to do the healing myself
- Modest Budget: I am willing to make an investment in my healing with The Pelvic Accelerator Coaching if it makes sense
- No Budget: I want fast and long-term results and I will invest in myself
If you were a tree what kind of tree would you be and why?*
How motivated are you to get started?
- I'm ready to start now! Let's do the strategy call and then get to the Pelvic Accelerator Coaching Program
- I'm somewhat ready. Just need the final push
- Not ready. I'm just browsing and looking for what's out there
Anything else would you like to tell me?