New Client Form | wellbeingbypenny.com

Welcome to the Pelvic Health Yoga membership

Thank you so much for being here, I am so excited to be working with you! It would be great if you could fill out this waiver, and feel free to answer all the questions so I can get a sense of who you are - in order for me to support you better. Your responses are kept strictly confidential and I look forward to hearing from you!

First Name

City/Country

Last Name

Occupation

Have you seen a pelvic physio prior to signing up for the membership? If yes, feel free to elaborate.

Do you live with hypertonic pelvic floor dysfunction?

Yes

How do I know if I do?

I would love to know more about your condition/s, what conditions have you been diagnosed with? What kind of pain do you live with? What are your pelvic pain symptoms?

What brought you here and what are you hoping to gain from working with me?

Well-being by Penny - Release & Waiver of liability

• I understand and appreciate the physical risks involved in a yoga practice and voluntarily assume any and all risks

• I am in proper physical condition to participate in this class or event

• I agree to release and forever discharge Pernilla Petersson & Well-being by Penny from any and all liability for any injury

• I understand that if I am unable to keep my scheduled private lesson appointment, I must offer the courtesy of 24 hours advanced notice via phone call or text

• If I offer less than 24 hours advance notice, I may be charged up to half the price of the lesson

• Same day cancellations will result in full payment

I agree to the terms & conditions

Welcome to the Pelvic Health Yoga membership

Thanks for submitting!