Trauma-Informed Hip Release Exercise Intake Form
Please complete this intake form to help us tailor your trauma-informed hip release exercise experience. No sensitive health or personal information is required.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
How would you describe your experience with hip mobility or release exercises?
*
Please Select
Beginner
Intermediate
Advanced
Other
What are your main goals or intentions for participating in this session?
*
Are there any movements or positions you prefer to avoid?
Do you have any accessibility needs or preferences for your exercise environment?
How comfortable are you with guided movement in a group or individual setting?
*
Very comfortable
Somewhat comfortable
Neutral
Somewhat uncomfortable
Very uncomfortable
Preferred session format
Group
Individual
No preference
Is there anything else you'd like to share to help us support your experience?
Submit Intake Form
Should be Empty: