Please fill in the Health Form below before attending your first session and press submit Open Form Health Screen Form Name * First Name Last Name Email * Emergency Contact Name First Name Last Name Emergency Contact Phone Number Medical Conditions Please tick any box that applies to you Heart associated problems High Blood Pressure Low Blood Pressure Vertigo/Dizzy spells Epilepsy Pregnant Respiratory or breathing issues Anxiety or panic Attacks Neuromuscular associated conditions None of these Apply Please add further information if you have ticked any of the above Joint or Back Problems Back Surgery Sciatica Arthritis in any joints Knee pain or surgery Shoulder surgery or pain Upper back pain Cervical Spine pain or surgery Please provide further Information here Current Health related to movement Are you been treated by a physiotherapist, osteopath or NHS referrals Yes No Please provide further Information What would you like to improve the most Posture Pain Flexibility Strength in Shoulders and Arms Strength in Back and Core Please feel free to provide anything else in this space below Thank you!
