Pelvic Health & Core Pre-Screening Questionnaire
Every woman is unique and your Core/Pelvic Health and/or incontinence issues will have their own unique origins. In order for us to assess whether this programme is right for you, we’d like you to assist us by answering the following questions as fully as possible. The answers you provide will help us to help you. Thankyou.
Holistic Core Restore® © Burrell Education 2012
The information that you provide will remain COMPLETELY CONFIDENTIAL. You will receive a copy of your answers as will your Coach, the creator of the programme, Jenny Burrell and our clinical consultant Michelle Lyons. This ensures that we can thoroughly assess your suitability for the programme and if further help is required outside the scope of exercise we can also assist you in finding this help. Please rest assured that the information you provide on this form WILL NEVER BE SHARED. Your privacy is extremely important to us.
Please ensure you answer ALL questions. Upon successful completion of this form, you will receive a confirmation message AND a copy of your answers to the email address given. If you DO NOT receive these, your submission has NOT been successful.