Name
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First Name
Last Name
Email
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Your Pronouns
1. Are you pregnant, postpartum / a parent, or trying to conceive? If yes, in what phase of that journey are you in?
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2. Are you currently, or have you ever been dealing with any symptoms such as diastasis recti, leaking, heaviness in your vagina or pelvis pain?
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3. Are you currently, or have you ever been dealing with any other pain/ injuries (e.g. low back pain, hip pain, shoulder pain)?
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4. Are you currently exercising or moving your body? Why or why not? (NO JUDGEMENT!)
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5. Why do you want to be exercising? What are your goals around movement for the next 3 months - 1 year?
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6. What has your relationship with your body, food, and exercise been like? (High level overview is fine!)
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7. Can you commit to 30-minute sessions once per week?
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8. Can you commit to being engaged in this flexible program for 3 months minimum?
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9. My current availability for 1:1 is Mondays 9:30-4pm EST (in-person) AND Tuesdays and Thursdays from 9:30am-4pm and Fridays from 9:30am-12noon EST (virtual). Would you be able to make this work with your schedule?
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10. The investment for this 1:1 program with Rhonda will be $150 for the 45-minute assessment and $100 per 30-minute weekly appointment. Is this something you can invest your finances and effort in?
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*Invoice sent after each session to submit for 3rd party physiotherapy benefits for Ontario residents
11. Are you looking for virtual or in-person support? (In-person appointments happen at Encompass Health and Wellness in Kitchener, ON)
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12. Anything else you would like to add?
