*1.Please provide me with your contact information.(Required.)

Name

Email Address

*2.What's Your Age:(Required.)

under 25

26-30

31-35

36-40

41-45

46-50

51-55

56-60

61+

*3.How Many Kids Do You Have?(Required.)

none

currently expecting my first

1

2

3

4+

*4.Are you currently or have you participated in any of Erica's programs/courses:(Required.)

Knocked-Up Fitness Prenatal membership

Core Rehab Program

Core Studio workouts + app

Pre/Postnatal Exercise Specialist Course or Certification

Worked 1:1 with Erica

Not yet

*5.What symptoms do you experience regularly or from time-to-time that you wish you could improve (choose as many that apply to you):(Required.)

Aches + Pains

Low energy / fatigue often

Trouble losing weight / holding onto extra weight

Incontinence (peeing your pants)

Bloating

Constipation (meaning less than 1 bowel movement per day)

Other digestive issues

Brain fog

Hormonal Swings / Mood Swings

Heavy periods

Anxiety

None of the above I feel GREAT!

Other (please specify)

*6.What are your top 2-4 interests(Required.)

Health / Wellness

Nutrition

Fitness

Outdoor / Adventure

Cooking / Baking

Shopping / Fashion

Literature / Arts / Reading

Music / Dancing

Spiritual

Listening to Podcasts

Entrepreneurial

Self-Development

Other (please specify)

*7.What's holding you back from reaching your goals:(Required.)

I'm currently working towards reaching my goal(s)

Not enough time

Motivation

Finances

Fear

Don't know how to get there or where to start

Pain or illness

Other (please specify)

*8.Preference on Podcast Length(Required.)

less then 30 minutes

30-45min

45-60min

I'll Listen Regardless of Length of Episodes

9.What would you like to hear on future podcast episodes? Do you have guest requests?