Congratulations on beginning your postpartum journey with Pilates

Before we start, please fill out this form so I can support you in the best way possible

First name*

Last name*

Address*

Email*

Yes, subscribe me to your newsletter.

Phone*

Birthday*

Tag

Monat

Jahr

Baby’s Birth Date:

Type of Birth:

Vaginal Delivery

C-Section

Other

Is this your first baby?*

Have you been cleared by your doctor or midwife to return to gentle exercise?

Yes

Not yet

Do you have (or have been diagnosed with):

Diastasis Recti (abdominal separation)

Pelvic floor issues (e.g., incontinence, heaviness)

C-section scar sensitivity or pain

Lower back or hip pain

Any other postpartum concerns?

Other

Are you currently breastfeeding?

Yes

What are your intentions for this course?

Rebuild strength

Support my pelvic floor & core

Relax and unwind

Connect with other mamas

Just some "me time"

Other

How did you find out about me?*

Anything you’d like to share with me?*

Are you recovering from an injury or illness / challenged by specific limitations or chronic pain?*

I sometimes share little class moments on Instagram— would you mind being included in these clips now and then? If you'd like to be tagged, feel free to share your profile name too*

How would you prefer to get the invoice?*

Mail

I understand that I participate at my own risk and that Valeria Künzli is not liable for any injuries.

I confirm that the information given is true and complete.

Signature

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