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IN MOTION Performance: New Client Intake Form
Welcome to IN MOTION Performance. Please complete this intake form so we can tailor your experience.
Full Name
*
Contact Information
*
Date of Birth
*
Occupation
*
Fitness Goals
*
Current Activity Level
*
Current Activity Level
A
Sedentary
B
Lightly Active
C
Moderately Active
D
Highly Active / Athlete
Emergency Contact
*
Medical History & Health Profile
Previous Injuries
*
Surgeries
*
Current Medications
*
Medical Conditions
*
Areas of Pain or Tightness
*
Lifestyle Habits
Average Hours of Sleep per Night
*
Daily Hydration
*
Stress Levels
*
Stress Levels
0
1
2
3
4
5
6
7
8
9
10
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