Revive Rehab PT Pelvic Floor Therapy Survey

Of the following, what is your biggest motivator to seek help?

Regaining trust in my body: be able to rely on my body functions to improve self-confidence. Overcoming fear of public embarrassment: not worrying about odor, wet spots, or needing to change clothes. Enjoy intimacy and feel connected again to myself or my partner: physical comfort and emotional confidence. Prevent future problems and protect long-term health: be proactive to prevent worsening symptoms Moving freely and returning to exercises and activities I love: unrestricted lifting, running, jumping, playing with kids and more. Empowerment: knowing and learning what's normal and that healing is possible.

What is your biggest/primary concern right now?

Bladder: leaks, urgency, frequency, pain Bowel: constipation, fecal urgency, loss of stool or stool staining, hemorrhoids, pain Core: weakness, diastasis recti, appearance, pain Prolapse: heaviness, pressure, feels like a tampon, feeling my organs/bulging Pain: low, mid, or upper back; SI joints; hips; tailbone; other joints Tension: tight pelvis, pain with tampon insertion, intercourse, frequent UTIs/yeast infections Menstrual, Perimenopause, Menopause associated pain, discomfort, other changes

What situations make you feel most self-conscious or anxious about your symptoms?

Sitting for a long period of time. Going to church, school events, or the gym. Planning travel or outings with family or friends. Worrying others can smell or see something.

Thank you for sharing and for your interest.

These can be challenging topics to address, so we're so glad you found us.

Name

Phone

Yes, I have read and agree to the Terms and Conditions. (Details here)

Thank you for your interest.

We will be in touch shortly.

Empowering Health Through Therapy
Revitalize Your Body and Mind
Experience the Revive Rehab Difference

Thank you!

Thank you for giving us some insight. Your feedback better helps us understand how to best serve our community and drives our commitment to excellence!

Empowering Health Through Therapy

Revitalize Your Body and Mind

Experience the Revive Rehab Difference