Pre-Discernment Chat Survey
**You are receiving this form as a result of requesting to schedule a Discernment Chat with us.**

Welcome to Womb Matters Holistic Physical Therapy!  We are so glad that you are taking this step to schedule a chat to discover what might be the BEST next step on your abdominal-pelvic healing path.  

A Discernment Chat is a 20-30 minute free video (Google Meet is our secure platform) or phone conversation scheduled between you and Beth Anne Fisher, PT, DPT, CSCS, WHC to learn more about your situation, your goals, and to help us discern together if we would be a good fit to collaborate on your healing together.  There is no pressure to commit to anything in these chats.  Beth Anne is well-connected to the holistic-conventional healing communities in Denver and is happy to discuss other options or providers with you if that is what's best for you after talking together.

Note that this chat does not replace a formal In-person or Telehealth evaluation, and licensed physical therapists in no way offer medical diagnoses, medication, or individualized supplement recommendations.  

We require that you take a few minutes to fill out the form below.  Beth Anne will contact you by email within 48-72 hours to set up the chat based on your answers to the questions below.

We look forward to chatting with you soon!
Sign in to Google to save your progress. Learn more
Email *
Name (First & Last): *
Best Phone number to reach you at: *
Does this phone number have a text function to communicate with you if needed before our scheduled time? *
Required
Would you prefer for the chat to happen over the phone or video?  My secure platform for video is Google Meet. *
Required
Have you read the "About You" and "FAQs" sections on the wombmatters website?  If not, please take a moment to do so as it provides some basic ideas in how we do pelvic health.  (https://www.wombmatters.com/you.html) and (https://www.wombmatters.com/faqs.html) *
Required
Have you had pelvic health physical therapy before? *
How did you hear about Womb Matters PT and/or Beth Anne Fisher? *
While Beth Anne is a cash-pay/ out of network physical therapy provider and does not work with insurance companies, she is still required to know which health insurance provider is your carrier.  ***Beth Anne is not able to work with people whose primary health insurance provider is Medicaid or Medicare, even if you intend to pay yourself.  Their rules do not permit this arrangement.  Beth Anne is happy to offer you options to for these situations if you need them.  Is your primary health insurance provider Medicare/Medicaid? *
Required
My main office hours for in-person bodywork sessions are Tues, Thurs, & some Fridays, with appts at 10am, 12pm, and 2/2:30pm.  Does that work for you?  If not, I will help you to find someone who has more availability as best I can. *
What is the main challenge that you are looking to address at Womb Matters? *
Anything else that you want to ask or that you want us to know before we set up the Discernment Chat:
I understand that this phone or video chat is educational in nature, and does not constitute medical or physical therapy advice specific to my condition.  This chat does not replace a full physical therapy evaluation and treatment plan, but only helps me to discern if working with Beth Anne PT is the next best step for my healing path. *
Required
Thank you for taking your time to fill out this form.  We will do our best to respond in 48-72 hours.  We look forward to connecting with you-
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Womb Matters PLLC. Report Abuse