Client Assessment | Divine Mama Strength

CLIENT ASSESSMENT FORM

First name

Last name

Phone

If pregnant, please share due date. If postpartum, please share your delivery date.

Month

Day

Year

What are your goals?

What are your biggest challenges right now?

What is your current workout routine? If not currently working out, when did you last have a routine and what type of workouts did you do?

What type of work do you do or daily activities do you do?

How has your sleep been?

How are your nutrition and eating habits right now?

Do you have any medical challenges that I need to be aware of?

If you went to pelvic floor therapy please share any information or recommendations from them.

How did you hear about Divine Mama Strength?

I agree to the website terms of use.