Appointment
Request
Name
*
First Name
Last Name
Age
*
Under 18 will require parental permission
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Preferred method of contact:
*
Please Select
Text
Phone call
Email
Precautions - proceed at your own discretion, consulting with a healthcare professional is advised:
*
Arthritis (eg Osteo, Rheumatoid, Juvenile).
Hypertension
Fibromyalgia
Chemotherapy or other high-risk medications
Disc herniation
Joint replacement
Neuro disorders (eg MS, stroke deficits, ALS, dysautonomia, etc)
None
Contraindications - checking any of these boxes unfortunately excludes you from services at this time :
*
I am currently pregnant.
I have a recent (60 days) and/or current muscle or joint injury, strain, sprain, tear, dislocation, etc or have had recent surgery or treatment for such.
Acute flare of joint(s) due to arthritis
Osteoporosis and/or compression fractures
Bruising easily or on blood thinners
None
Please list your Profession, Physical activities, Sleep habits, Hobbies and any past stretch/flex experiences here:
*
I agree to the following:
*
I certify that all statements and information provided above are true, complete, and correct to the best of my knowledge.
I understand repeated failure to show or failure to reschedule my appointments in a timely manner (24 hours prior) will result in being blocked from this schedule.
Signature
Appointment
Services
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Flexibility & Stretch Consultation
60 minute appointment = assessment + an assisted stretch session
$
65.00
Stretch Session
Includes one 45 min assisted stretch session (15 min intake + 30 min stretch)
$
30.00
Personal Training Session
1:1 kettlebell coaching, includes one 45 minute session
$
30.00
Mobility Sticks
Special mobility technique designed for athletes & enthusiasts including golf, running, racket sports, and more. Includes one 45 minute session (15 min intake + 30 min stretch)
$
30.00
Payment options accepted at time of service (I do not accept gratuity) :
Credit, debit, prepaid or gift cards with a Visa, Mastercard, American Express, and Discover logo
Venmo
Cash (no personal checks)
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