Client Record Please complete the fields in this form below to enable me to provide the most suitable program Go backYour message has been sent Name(required) Warning Email(required) Warning Date of birth Warning Address Warning Contact Number Warning 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) Warning Are you taking any regular medication either prescribed or over the counter. If yes , please list, otherwise please state No.(required) Warning 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) Warning Is there any other information that you believe will be relevant? Warning What are your 3 main aims for undertaking the sessions?(required) Warning Warning. Submit Δ Share this: Click to share on X (Opens in new window) X Click to share on Facebook (Opens in new window) Facebook More Click to share on WhatsApp (Opens in new window) WhatsApp Like Loading...
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