Thank you for your interest in training. Please fill out the following questions to give me a better sense of how I can help you.

Name *
Another way of asking this question: In what positions does your body live in for much of the day?
Please describe your physical goals, both short-term and long-term.
Exercise and Medical History
Movement experience and medical history
Please list types, frequencies, and intensities of activities that you do in a given week.
Please list all sports or other physical activities with which you have experience.
Movement Competency *
Movement Competency
I am very comfortable performing fundamental movement patterns, such as squats, deadlifts, rows, presses, and planks.
Please rate your level of agreement with the statement:
Please list any surgeries or injuries (current or past). If you can remember when they occurred, please provide dates.
Please elaborate on any physical conditions that may limit your participation in an exercise program.
Please list the treatments or therapeutic protocols you have tried for your injuries.
Please list all medications you are currently taking.
Pregnancy *
Is there any chance that you are pregnant?
Please check Yes or No for the following questions.
Has your doctor ever said that you have a heart condition and that you should only perform activity recommended by a doctor? *
Do you feel pain in your chest when you perform physical activity? *
In the past month, have you had chest pain when you were not performing any physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Do you have a bone or joint problem that could be made worse by a chance in your physical activity? *
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition? *
Do you know of any other reason why you should not engage in physical activity? *
No detail is too small (urological issues, high levels of work stress, poor sleep quality, etc.). You are a complex being and, therefore, one seemingly small stressor can effect the rest of the system.
Verification *
Please check the box below to indicate that, to the best of your knowledge, you have answered the questions truthfully and in sufficient detail to alert me of any medical considerations that may impact our work together.