Pelvic Floor Stretching Routine Form
Please complete this form to track your pelvic floor stretching routine and share your feedback.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you previously practiced pelvic floor stretching?
*
Yes
No
What is your primary goal for this routine?
*
Please Select
Improve flexibility
Reduce pelvic discomfort
Support postpartum recovery
Increase core strength
Other
Do you currently experience any pelvic pain or discomfort?
*
Yes
No
Please indicate which stretches you performed today:
*
Child's Pose
Happy Baby Pose
Deep Squat
Butterfly Stretch
Pelvic Tilts
Other
On a scale of 1 to 10, how difficult did you find today's routine? (1 = very easy, 10 = very difficult)
*
Very Easy
1
2
3
4
5
6
7
8
9
Very Difficult
10
1 is Very Easy, 10 is Very Difficult
Did you experience any pain or discomfort during the stretches?
*
No discomfort
Mild discomfort
Moderate discomfort
Severe discomfort
How satisfied are you with your progress so far?
1
2
3
4
5
Additional comments or feedback
Submit Routine
Should be Empty: