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Pelvic Health Screening & Assessment

NUMI screening and assessment ensures that every client receives the most effective and appropriate treatment for their pelvic health concerns. By completing this form, we can assess your needs, determine suitability, and provide tailored recommendations before booking your first session.

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 This step is required before scheduling any treatments.

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Step 1: Complete Your Online Pre-Screening

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  • Fill out the confidential medical intake form with details about your pelvic health concerns, medical history, and treatment goals.

  • Takes just 5 minutes to complete.

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Step 2: Professional Review

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  • Our team reviews your submission to determine if NUMI’s pelvic floor therapy is right for you.

  • If needed, we’ll reach out for clarification or additional details.

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Step 3: Booking Confirmation

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  • Once approved, you’ll receive an invitation to book your first session in the 6-Session Foundation Program.

  • If NUMI therapy isn’t suitable for you, we’ll guide you toward the next best steps for your pelvic health.

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Birthday
Year
Month
Day
Do you have a pacemaker or any other implanted electrical device?
Do you have any metal implants near the pelvic area?
Have you had any recent pelvic injuries or surgeries?
Do your suffer from any Neurological disorders (eg Epilepsy, MS)?
Are you currently pregnant or trying to conceive?
Are you currently under the care of a doctor for any medical treatements?
Are you currently on any medications?

Please select all that apply

If yes to any of the above, how long have you experienced these symptoms
Have you sought treatment for any of these symptoms
How often do you engage in sports or physical activity
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