Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Please list any injuries and surgeries you have had *Please list any medical conditions ie: diabetes, high blood pressure *Do you experience muscle or joint pain? *Yes, on a daily basisYes, but less than 2 times a monthEvery now and then- few times a yearNo, no painDescribe the type of pain you feel...If none put N/A *How much experience do you have with exercise? *Exercise at most 1 time a weekExercise regularly 2 or more times a weekI have exercised on and off for several yearsI have never exercisedPlease list the type of exercises you do regularly. ie: running, weight lifting, cyclingDo you believe you drink enough water daily?YesNoUnsureAbout how many hours of sleep do you get at night?Is it difficult for you to get on and off the floor?YesNoDo you take prescription pain medication to help ease pain? *YesNoIf yes, how often do you take medication?What are your goals for this program? What do you hope to achieve? *Submit
