Stretching Intake Form
Please complete this form before participating in your stretching session. Your responses help us tailor the experience to your needs and ensure your safety.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name and Relationship
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What are your main goals for stretching?
*
Increase flexibility
Reduce muscle tension
Improve posture
Aid recovery from injury
Other
Do you currently experience any pain, discomfort, or physical limitations?
*
No
Yes (please explain below)
If yes, please describe the pain, discomfort, or limitations.
Please indicate any relevant medical history (e.g., injuries, surgeries, chronic conditions).
*
How would you describe your current activity level?
*
Not active
Lightly active
Moderately active
Very active
Are there specific areas of your body you would like to focus on?
Neck
Shoulders
Back
Hips
Legs
Other
Is there anything else we should know to help make your stretching session safe and effective?
Signature (please sign below to confirm your consent and understanding)
*
Submit
Submit
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