Daistasis Fitness Application Form
Hi and Welcome!
I love that you're here and interested in working with me.

Filling out this form will help me get to know what you need help with and have a better idea if we would be a good fit to work together.
Make sure you answer questions with as much detail as you can so I have some background on any symptoms you're feeling and where you're starting from.

I'll be in touch soon,
Email address *
Name: *
Age: *
How many kids do you have? How old are they? *
What symptoms are bothering you ? What are you feeling? *
What have you tried before to fix this and why do you think it didn't help you? *
What's your goal and how will you know you've been successful? *
Do you realize that while I can prescribe a personlized rehab programme for you, you won't see results if you put the work in? *
Do you have at least 15 minutes a day to devote to your core and pelvic floor rehab programme? *
Is there anything else you think I should know about you and your symptoms? Do you have any other health issues that might interfere with exercise? *
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