Resilience Physical Therapy
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Appointment info
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Prescreener
Reason for care
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Contact information
What is the reason for seeking care? Check all that apply.
Pre pregnancy care
Pregnancy care and/or delivery preparation
Postpartum care
Urinary symptom (leakage, difficulty emptying, urgency, other)
Bowel symptom (constipation, loose stool, urgency, leakage, other)
Pain (low back, pelvic, pain with sex or insertion, abdominal pain, hip pain, other)
Other
Have you been pregnant before, or are you currently trying to become pregnant?
Check all that apply
I have been pregnant before
I have had a miscarriage(s) or abortion before
I have had a cesarian birth
I have had a vaginal birth
I have never been pregnant before
I am currently trying to become pregnant
I am not currently trying to become pregnant
It's possible I could become pregnant in the next year
If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.
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