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1. First Name *

2. Email *

3. What type of pelvic floor condition are you suffering from? (in medical terms or layman’s terms) *

4. How long have you been suffering with your current condition?* *
Less Than 6 Months6 Months to a Year1 to 5 YearsMore Than 5 Years

5. What do you think caused your condition? *

What are your top 3 goals for your session? *

6. What is the biggest barrier or barriers you need to overcome in order to achieve your goals? *

What have you tried thus far that has helped relieve your symptoms? *

How Would Your Life be Transformed When Healed *

Which Winnie the Pooh character best describes your healing mindset? *
Tigger the TigerWinnie the PoohEeyore the DonkeyPiglet the Pig

What types of medications and/or supplements you are taking? *

Do you have abdominal scars, surgeries, or any birth history? *

Have you purchased any of Isa’s online programs? If yes, which one(s)? *

Have you had any emotional upset in the past year? *

Anything else you would like us to know prior to your session? *

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