The Postpartum Rebuild Method™ 1:1 Coaching Application

1

Please provide your full name* This field is required.

First Name

Last Name

2

Best email address to reach you* This field is required.

Please provide a valid email for correspondence

3

Best phone number to reach you (with country code)* This field is required.

Please enter a valid phone number.

4

Preferred method of communication regarding this application* This field is required.

Text

Email

5

Are you comfortable being contacted via your selected method?* This field is required.

Yes

No

6

How many months postpartum are you? (If applicable)* This field is required.

0–3 months postpartum

3–6 months postpartum

6–12 months postpartum

12+ years postpartum

Not recently postpartum, but I am a mother

7

Delivery method (if applicable)

Vaginal

C-section

Both

Not applicable

9

Have you been medically cleared to exercise?

Yes

No

10

What is your primary goal over the next 12 weeks?* This field is required.

Lose body fat

Rebuild core strength & stability

Eliminate pelvic floor symptoms

Feel confident in my body again

Build strength & muscle

Create structure & consistency

Other

11

What feels most frustrating about your body or fitness right now?

12

Why is now the right time for you to make this change?* This field is required.

13

How many days per week can you realistically train?* This field is required.

2–3

3–4

4–5

5+

14

Are you prepared to commit to a structured 12-week coaching program?

Yes

No

15

On a scale of 1–10, how committed are you right now?

16

Are you prepared to make a financial investment into your health at this time?* This field is required.

Yes, I am ready to invest in coaching.

I am open to discussing options.

Not at this time.