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Sign up for Yummy Tummy Rescue Programme (6 weeks)

Name*
First Last
Email*
Phone
How motivated do you feel?
- I'm all set and raring to go: Bring It On!
- I know I need to do this but I'm easily distracted
- I need major hand holding or this won't happen
Before and After shots!
Add your front view 'before' photo here please:
Accepted file types: jpg, gif, png, Max. file size: 2 MB.
maximum 2MB (don't include your head and shoulders in the photo)
Add your side view 'before' photo here please:
Accepted file types: jpg, gif, png, Max. file size: 2 MB.
maximum 2MB (don't include your head and shoulders in the photo)
Would you give us permission to use your photos on social media?
- yes
- no
No problem
Thank you! I'll be in touch asking you to give me signed permission.
Tell me more about you
I need to know about your medical history*
Particularly need to know if you've ever had any back problems, and how many children you've had.
What kind of exercise do you already do?*
What type of exercise and how often?
What are your hobbies?
Do you have any worries about your diet?
How would you describe your posture?
- Ideal alignment
- kyphosis and lordosis
- Flat-back posture
- Sway-back posture
Check out the posture analysis photo to decide which is most like you.
How long can you 'hold' your pelvic floor?*

how many seconds?
Have you checked your dialysis split?*
- Yes
- No
Is your tummy separated?*
- Yes
- No
- Not sure
by how many finger widths?*
- 1 - 2
- 2-4
- more than 4
Before starting the Yummy Tummy Rescue Programme we need to find out if your tummy has separated, and if so, by how much. Please read this short document - if you're still not sure, contact me through the website and I'll help you work it out. You can still complete this form today. Thanks, Hannah
You need to do the exercises 3 times a day - select 3 times that suit you best:*
- first thing in the morning
- after breakfast
- mid morning
- lunchtime
- mid afternoon
- late afternoon
- before supper
- at bedtime
Finally, it would help me to know how you heard about the Yummy Tummy Rescue Programme:*
- Word of mouth
- Farnham Pilates website
- Marketing email
Anything else you want to tell me about?
Payment
Yummy Tummy Rescue Programme (6 weeks)
Price:

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