Name *

First Name

Last Name

I can commit to (at minimum) 50 minutes per week to participate in the pre-recorded online classes of the program *

Yes

No

I can commit to partaking in the 4-Week Online Program starting Monday April 15th *

Yes

No

I can commit to filling out an online feedback form after partaking in the program *

Yes

No

I can commit to providing a short written testimonial in reference to my experience partaking in the program, and grant HealthyHips permission to use said testimonial for marketing purposes *

Yes

No

I experience tightness or stiffness in my hips on regular basis *

Please note that your answer does not have to be "Yes" to this question for you to be able to participate in this program

Yes

No

I experience tightness or stiffness in my lower back area on regular basis *

Please note that your answer does not have to be "Yes" to this question for you to be able to participate in this program

Yes

No

I have had postpartum hip or low back pain, either currently or in the past year *

Yes

No

Not Applicable

If you have an instagram account, would you be willing to post a few stories about the HealthyHips 4-Week Program while you are participating in it? *

Yes

No