GET IN TOUCH

Thank you for your interest in us! We're eager to guide you towards a future of enhanced posture and vitality. Complete our assessment form to give us a snapshot of your needs. Let's book your personal assessment and kick-start your transformation with our expert team!

Inital Assessment Form

First Name *

Last Name *

Date of birth *

Gender *

Phone *

Email *

Instagram Handle (if you have):

How did you hear about us? *

Instagram

Google

Facebook

Other

If other, specify

Best way to contact you? *

Occupation *

Training you are interested in? *

The best days and times for you to train? *

Have you started the Functional Patterns 10-Week Online Course? *

Are you in chronic pain? *

Yes

No

If yes, please tell us more about your chronic pain and rate each of your painful areas 0-10 (0=no pain, 5=moderate pain, 10=worst possible pain):

Do you have any past or current significant injuries and/or surgeries? *

Yes

No

If yes, please tell us more about your injuries and/or surgeries:

Do you have scoliosis? *

Yes

No

If yes, please tell us more about your scoliosis:

If yes, please upload any x-rays or scans of your spine that may help us view this issue:

Are you currently doing any following exercises and/or therapy? *

If you're doing any exercises and/or therapy outside of these methods, please elaborate:

How willing are you to stop these current exercises/therapies while initially learning Functional Patterns? (1 being completely unwilling, 4 being very willing)

Are you vegan, vegetarian, pescatarian, or anything of this nature? *

Yes

No

If yes, please tell us the nature of your current diet:

If yes, how open are you to changing your diet if you were presented with information that a diet that included animal products is essential to your recovery and health? (1 being completely unwilling, 4 being very willing)

Are you currently a fitness professional, movement coach, manual or physical therapist? *

If yes, please specify

Please explain anything else you would like us to know

GET IN TOUCH

[email protected]

786-200-8154

11845 S Dixie Hwy Pinecrest, Florida 33156

11845 S Dixie Hwy, Pinecrest, FL 33156, USA

GET IN TOUCH

Inital Assessment Form

GET IN TOUCH

786-200-8154

11845 S Dixie Hwy Pinecrest, Florida 33156

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