Client Record Please complete the fields in this form below to enable me to provide the most suitable program ← BackThank you for your response. ✨ Name(required) Email(required) Date of birth Address Contact Number Do you have any bone / joint or on going mobility issues (whether or not you are seeing the DR / Practitioner) that limits your day to day movement? If yes, please describe below or state No(required) Are you taking any regular medication either prescribed or over the counter. If yes , please list, otherwise please state No.(required) Do you have any heart, lung, breathing or blood pressure issues (including Asthma)? If yes please state any Dr.s advice given in the management of the condition. Otherwise state No.(required) Is there any other information that you believe will be relevant? What are your 3 main aims for undertaking the sessions?(required) Submit Δ Share this: Share on X (Opens in new window) X Share on Facebook (Opens in new window) Facebook More Share on WhatsApp (Opens in new window) WhatsApp Like Loading...
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