Apply To Work With Three Sixty Wellness

Thank you for your interest in working with The Three Sixty Wellness Team. We are equally as excited to help you reach your goals as you are hoping to achieve them! Fill out this form below and then find a time to book a video call on the next page.

First Name *

Last Name *

Email *

Phone *

Instagram Handle *

How did you hear about us?! *

Instagram

TikTok

Facebook

Friend/Word of Mouth

Other (please list below, or mention your friend!)

Who were you referred by? We love to send thank you's!

Click all that apply to you: *

Leakage

Urgency to urinate

Frequently Urinating

Low back pain/SI joint pain

Hip pain

Tailbone pain

Abdominal pain

Painful intercourse

Pelvic floor tension

Rib flaring

Constipation

Pelvic pressure/heaviness (prolapse)

Urinary retention

Frequent UTIs

Lack of sexual arousal

Pregnancy pains

Painful urination/bowel movement

Other not listed

What other fitness, health, or weight loss struggles do you have outside of your pelvic health? *

How long have you been struggling with these issues? *

< 1 year

1-2 years

2+ years

Which one best describes you currently? *

No children

I am currently pregnant

I am < 1 year postpartum

I am > 1 years postpartum

I am perimenopausal

How old are you? *

What do you do for a living/what is your career? *

What are the biggest hurdles you’ve been trying to overcome on your own? *

Have you tried anything in the past (In-person PT, training programs, diets, etc.)? What made those things difficult to stick with/follow through long term? What did the financial commitment look like? *

What are your top fitness, identity and lifestyle goals for the next 6+ months? Why is this important to you? *

What made you decide to apply to Three Sixty Wellness specifically? What about this program stood out to you? *

If it feels like the right fit, are you prepared to invest in the support and accountability needed to finally see lasting results with our team of Doctors of Physical Therapy? (Coaching starts at $10-$15 USD/day)

Will you need another person involved in your financial decision-making? If so, will your partner be joining this call? *

Anything else you'd like to add before booking?

Submitting this form confirms you’re ready to move forward and will be present for your call.