Client Record Please complete the fields in this form below to enable me to provide the most suitable program 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:TwitterFacebookMoreWhatsAppLike this:Like Loading...
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