Pole Therapy Master Class Information Form
Once we receive your information the team will send you the master class information including a list of suggested items needed for the class and all login and class info. See you on November 9th.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
zip code
What are you hoping to get out of the pole therapy group? Please give as much information as you can. There are no right or wrong answers just want to get to know you as an individual.
Have you been in traditional therapy before?
Please Select
Yes, currently in therapy
No, Never had any sort of therapy
Yes, in the past
How would you describe your pole experience?
Very Very Beginner, never touched a pole
Beginner, I have taken a class or few classes
I feel comfortable on the pole, I have been to several classes and can do many of the basics.
Intermediate or above. I can climb, invert, and do some pole combos and tricks
I would like to improve? (please check all that apply)
Improve Confidence
Decrease Anxiety
Decrease Sadness/Depression
Become a Better Version of Me
Gain Clarity
Change My Thought Pattens
Less Scattered, More Orgainzied
Work on Relationship Issues or Skill
Submit
Should be Empty: