Back Extension Stretching Routine Form
Plan and track your back extension stretching routine with this simple form.
Full Name
*
First Name
Last Name
Date of Routine
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preferred Time for Routine
Hour Minutes
AM
PM
AM/PM Option
Current Physical Condition
*
Feeling great
Mild stiffness
Sore or tight
Other
Select Back Extension Exercises
*
Prone Press-Up
Standing Back Bend
Cobra Stretch
Superman Exercise
Other
Total Duration (minutes)
*
Intensity Level
*
Please Select
Low
Moderate
High
Equipment or Setup Used
Yoga mat
Foam roller
Towel
None
Other
Target Areas for Stretching
Lower back
Mid back
Upper back
Glutes
Other
Additional Comments or Observations
Submit Routine
Should be Empty: