Please answer each question carefully and completely. This is very important
information and will contribute significantly to the development and implementation
of your personal health and fitness program. We want you to be successful,
and want to truly understand the demands you face each day. If you have
any questions, please submit at the end of the questionnaire.
Do you currently have, or have you in the past had complications with
any of the following (Check all that apply):
Please list all medical care providers, the reasons for seeing them, and
any contact information.
How would you describe the emotional climate/level of stress in the following
This includes significant physical pains and injuries you have experienced,
even ones you may consider minor, non-medically treated injuries or events.
PLEASE NOTE: the younger you experienced injuries, the more effect they
may have had, so please consider everything you can remember, including
your age when each “trauma” occurred.
Do you have, or have you in the past had any of the following complications,
including any pain, injury, surgery, loss of function. Please include AGE
OF INJURY FROM CHILDHOOD UNTIL RECENT and whether it affects you currently
with a “C”.
Please include F.I.T.T. details for past training (if no longer training)
or current training:
Our focus is to build a solid, balanced base to help you for life-optimizing
injury prevention, treatment and function. Our strategy includes identifying
past imbalances and weaknesses and optimizing the entire body’s function,
which may include training differently than you have in the past, we look
forward to working with you to find optimal solutions.
Thank you for completing the client profile. Please hit submit and you
will receive a confirmation email.