Intake form: Health Questionnaire

Do you or have you suffered from any of the conditions below? *

If you have answered 'YES' to any of the above, please give details
Goal for the session
Are you pregnant, or have you been pregnant within the last year?

Yes No
I have read, understood and completed this questionnaire. I understand that stretching sessions may lead to some muscle soreness for a few days after treatment.

All the information I have given above is correct to the best of my knowledge.
Signed
Date
Should be Empty:

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