Full Name *

Phone *

Email *

City

State

What stage of life are you currently in?

Trying to conceive - Preparing for pregnancy

Pregnant - Staying Active

Pregnant - Struggling to Stay Active

Postpartum - Just Starting Recovery (0-6 months)

Postpartum - Trying to Return to Running/Lifting/CrossFit

Postpartum - Struggling with Symptoms (Leaking, Pain, Diastasis, Prolapse)

If Pregnant how many weeks are you?

What is your biggest challenge right now? (pregnancy/postpartum fitness related, select all that apply)

Core weakness (feeling disconnected, unstable)

Leaking during workouts or daily activity

Pelvic pain/pressure

Trouble returning to lifting, running, or working out without discomfort

Painful intercourse postpartum

Not sure what exercises are safe

Lack of time & energy to focus on recovery

Birth prep

Learning how to push effectively

Please explain what you biggest challenge in your own words!

Do you have any specific concerns you’d like us to address?

SERVICE PREFERENCES

What's holding you back from booking right now?

How did you hear about Fit2Push?

Instagram

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Friend

In-person Event

Google

Referral

Would you like me to send information about pricing and how I work?

Yes

We occasionally send updates, educational resources, and check-in messages to clients who are interested. Please let us know if we have your permission to reach out. *

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