Step 2. Fill Out the Application Information Name(Required) First Last Email(Required) Best Phone or Skype(Required)What Is Your Occupation?(Required)What kind of activities does your condition prevent you from doing or enjoying?(Required)Does your condition impact your ability to work? Yes NoType of Pelvic Floor Condition You Are Suffering From? (in Medical terms or Layman's Terms)(Required)How long have you been suffering with your current condition?(Required)< 6 months6 months to a 1 Year1 to 5 YearsMore Than 5 YearsDo you feel like your condition can improve? yes noWhat do you think caused your condition?(Required)What is the biggest barrier or barriers you need to overcome in order to achieve your goal?(Required)What have you tried thus far that has helped relieve your symptoms?(Required)If you had a magic wand and would be able to cure your pelvic pain, how would your life be transformed?If you were given a solution to your condition that would teach you how to alleviate your current symptoms and give you a long-term roadmap for success, what would you be willing to invest?(Required) $1000-$1500 $1500-$3500 $3500-$5000 $5000-$7000Which Winnie the Pooh character best describes your healing mindset?-- select oneTigger the TigerWinnie the PoohEeyore the DonkeyPiglet the PigIf you were a tree what kind of tree would you be and why?(Required)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 thereAnything else would you like to tell me?CAPTCHA
