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BIOMECHANICS FITNESS TRAINING

BIOMECHANICS FITNESS TRAINING

BIOMECHANICS FITNESS TRAINING

Please complete the intake and liability release forms in preparation for your initial consultation.

Please complete the intake and liability release forms in preparation for your initial consultation.

1.

Background History and Intake Form

Birthday
Month
Day
Year

Myofascial Information

Do you experience any of the following?

Pain & Scars

If you have pain, is it:
Does this condition affect your sleep in any way?
Yes
No

Bio-structural Information

Check any of the following you have had problems with in the last 6 months:

Exercise

Do you exercise?
Yes
No
How often do you exercise:
How long is your average exercise session?
Are your exercise sessions hampered due to pain or injury?
Yes
No

Health and Fitness Goals

Please check goals that are important to you:
Where do you plan to exercise?
Have you experienced any of the following difficulties with an exercise program in the past?

Medical History

Are you interested in improving your health to reduce your need for medication?
Date
Month
Day
Year

2.

Disclosures and Cancellations

Release of Liability

I voluntarily submit my application for attendance and participation to train, and do herby assume full responsibility for any damages, injuries, or losses that I may sustain or incur while attending or participating in all activities offered by practitioner. I waive all claims against the owner or practitioner, individually or otherwise for any claim of injury that I may sustain. I fully understand and recognize that strict adherence to the rules and regulations relative to training and participating in classes must be observed. I accept full medical and legal responsibility for the use of any techniques learned while training with practitioner. I understand that any medical treatment given me will only be of a first type.

Date
Month
Day
Year
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