Make a Quantum Leap Forward with Your Pelvic Health with Expert Coaching. >> Apply Below Fill Out THis Form to Apply: 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?YesNoType 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?*< 6 months6 months to a 1 Year1 to 5 YearsMore Than 5 YearsDo you feel like your condition can improve?yesnoWhat 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 - $20,000Which Winnie the Pooh character best describes your healing mindset?-- select oneTigger the TigerWinnie the PoohEeyore the DonkeyPiglet the PigHow 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 myselfModest Budget: I am willing to make an investment in my healing with The Pelvic Accelerator Coaching if it makes senseNo Budget: I want fast and long-term results and I will invest in myselfIf 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 ProgramI'm somewhat ready. Just need the final pushNot ready. I'm just browsing and looking for what's out thereAnything else would you like to tell me? This iframe contains the logic required to handle Ajax powered Gravity Forms. Copyright 2019 PPR Associates , INC | Terms of Use | Privacy Policy
