In order to save time, please complete this intake form prior to your first visit

 

If you are starting care to manage pelvic floor dysfunction, then please complete this questionnaire prior to your first visit

 

If you are starting care for pelvic pain in pregnancy, then please complete this questionnaire prior to your first visit.

 

If you are not sure whether you should start pelvic floor physical therapy, then completing this questionnaire can help both of us determine if you are a good candidate. If you are beginning treatment for low back, hip, or other pain, then this questionnaire will also help to determine whether your pelvic floor is also involved.