First Name
*
Last Name
*
Email
*
Phone
*
What is your area of concern?
*
"Mom pooch" or core weakness
Prolapse
Pain with intercourse
Postpartum
Low back pain
Pelvic pain
Hip pain
Pregnancy/birth prep
Urinary leakage
Constipation
Male pelvic health
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How long have you suffered/worried about this?
*
A few days
1-2 weeks
Less than a month
1-3 months
Years
Looking for preventative/wellness care
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What concerns you most about this issue?
*
The pain I'm experiencing
Fear of not being able to stay active
Concerned about not knowing what's wrong
I'd like to avoid medications or surgery
Concerned about lack of improvement
Future ill health
I'm doing well now and want to stay in good health
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Which clinic are you requesting more information about?
*
Saginaw Clinic
Troy Clinic
Virtual Services Only
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