New Client Consultation Form

First name

Last name

Email

Phone

How did you hear about us?

Friend

Social Media

Physician

Other

What are your goals for pelvic floor physical therapy?

Treat a known condition

Be proactive and prevent pelvic floor issues!

Postpartum healing and return to sport assessment

To learn more about my body

Have you discussed these symptoms/concerns with your healthcare provider and been cleared for pelvic floor physical therapy?

Clients see the best results when they can commit to about 20-30 minutes/day to exercises and communication with Dr. Lynne. Can you make that commitment?

Yes

No

On a scale from 0–10, how ready are you to start improving your pelvic health today? 0 = Not ready at all, 10 = All in and ready to start!

New Client Consultation Form

Contact me!