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?
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?