Working with Bliss Physical Therapy and Pilates!

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Welcome to Bliss Physical Therapy and Pilates! We’re here to support you on your journey toward better health and well-being through personalized pelvic floor physical therapy. Thank you for your interest in working with us. This application will help us get a better understanding of what you are looking for and to see if we are a good fit for you! As PT is progressive in nature and requires time and commitment, plans of care vary from person to person as well as based on your individualized goals. We are here to help you feel your best. Let's get started!

After reviewing the form, we will reach out to set up a complimentary discovery call within 2 business days. In the meantime, if you have any questions, feel free to reach out to us via our website at www.blissptpilates.com or email us at disha@blissptpilates.com

Full Name *

Email Address *

Phone Number *

What stage of women's health category do you relate yourself best to? *

Currently Pregnant

Newly Postpartum (< 6 weeks)

Postpartum (Less than 6 months)

Postpartum (More than 6 months)

Planning for a Child

Want to resolve pelvic floor issues (Urgency, Diastasis Recti, Pelvic Organ Prolapse, Incontinence, Constipation)

Decrease pain (with daily functioning, caring for your baby, with being intimate)

Orthopedic Issues

Other:

Required

If you are < 1 year postpartum when was your most recent delivery

YYYY

If you are currently pregnant when is your due date?

YYYY

How did you hear about us? *

Referral from a health care provider

Social Media

Other:

Required

Have you ever had physical therapy prior to this? *

Yes

Please describe your most important goals you would like to achieve from working with us?

What does your week look like in terms of your physical activity/exercise/work?

The 1:1 coaching and physical therapy program provides a highly personalized and supportive experience, tailored to meet your specific needs. It is designed to seamlessly integrate into your life, ensuring you are consistently taking the most effective steps to achieve your goals. On a scale of 1-10, how ready are you to commit to starting now? *

Not ready but would like more information on it

Ready to get help as soon as possible

I agree for Bliss Physical Therapy Services to reach out via email, text and/or phone call. *

Yes

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