Personal Circumstance Help us match you with the right therapist by answering a few questions. PreviousNextDoes any of the below apply to you? (Select all that apply) I am currently pregnant I have given birth in the last 2 years I am going through menopause Other (please specify)When did you give birth? What is your due date?PreviousNextWhich of the following are you currently experiencing? (Select all that apply) Leaking urine (e.g. when coughing, laughing) Urgency to urinate Pelvic heaviness or vaginal bulge Pain during intercourse Constipation or straining Leaking wind or stool Pelvic pain Back or hip pain Diastasis recti (abdominal muscle separation) None of the above Other (please describe briefly): PreviousNextThe following questions are here to screen out any serious conditions that require urgent medical attention. If you answer 'Yes' to any of them, we'll kindly recommend that you speak to your GP or call 111 before continuing. You won't be able to proceed with booking just yet.Have you experienced unexplained vaginal bleeding or discharge? Yes NoHave you noticed a sudden bulge or heaviness in your vagina that worsens during the day? Yes NoHave you had recent pelvic surgery or complications? Yes NoImportant Notice Thank you for completing the questionnaire. Your health is our top priority. Because you answered "yes" to one of the "red flag" questions, we don't believe booking an appointment through Mothercore is right for you at this time. We kindly recommend that you either book an in-person appointment with a healthcare professional or contact NHS 111 for further guidance. Thank you for your understanding.PreviousNextOn a scale of 1 to 10, how much are these symptoms affecting your daily life or emotional wellbeing?5PreviousNextThis information will only be used to match you with an appropriate therapist and help them tailor care to your specific needs. Your data will be handled in accordance with our Privacy Policy. By ticking this box, you consent to Mothercore collecting and securely sharing your triage responses—including information about your pelvic health symptoms, pain levels, and any red flags—with qualified physiotherapists on our platform. I agree to the Terms and Conditions of Use Terms and Conditions Previous Submit Form
