Hip-Knee-Foot Clinic Sign-up Form

Hip-Knee-Foot Clinic

Making each step better!
You are now a step closer to unlocking real freedom in your body. The Hip-Knee-Foot Clinic is a game-changer! Whether you’re tired of feeling stiff, trying to bounce back from an injury, or pushing for peak performance, this is for you.

This is a mobile (outdoors or at your home service) so no need to travel, the clinic comes to you.

Sessions last 60 minutes and you should expect to build strength, flexibility, and injury-proof movement, week after week. And yes, there’s homework to keep the progress going!

Don’t wait. Complete the form below.
Full name

First NameLast Name
E-mail
example@example.com
Mobile number for text/WhatsApp updates
Format: 00000-000-000.
Client information - Health questionnaire (Par-Q)

Please read the questions carefully and answer: YES or NO.

Par-Q

Rows	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel fain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?
Do you have any hip, knee or feet issues?
Do you have any lower back issues?
Are you able to physically take part in low-to-moderate intensity movement-based activity?

Please describe your current fitness, injuries or any physical obstacles relating to your back, hips, knees or feet:
Click here to read the Hip-Knee-Foot Clinic terms and conditions.
Now you have read the terms and conditions containing the pricing structure, which payment option suits you?
Terms and Conditions Confirmation
Initials
Client informations - Signature
Signature
Date

JourMoisAnnée
Date
Should be Empty:

Hip-Knee-Foot Clinic