Client Snapshot — ManlyMovement

Client Snapshot — ManlyMovement

Share your training background, injuries, goals, and scheduling preferences so we can make our first conversation count.
About You
First Name
Last Name
Email
example@example.com
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Age
What is your occupation?
Which track are you most interested in?
How did you hear about ManlyMovement?
Training History & Injuries
Have you trained consistently before?
What kind of training have you done?

Other
How long since your last consistent training block?
Do you have any current or past injuries, surgeries, or diagnosed medical conditions I should know about?
Please describe — including approximate dates and whether it's fully resolved.
Do you have any current or past injuries I should know about?
Please describe your injuries (what, when, and current status)
Have you had any surgeries?
Please list your surgeries (what and when)
Do you have any diagnosed medical conditions?
Please list your diagnosed medical conditions
Are you currently taking any medications or supplements?
Please list each medication or supplement (name, dose, and what it's for)
Do you have any current pain, or areas you would like me to avoid or be careful with?
Please describe the area(s) and what to avoid
Are you currently cleared by a physician for exercise, or do you have movement restrictions?
Please describe your restrictions.
Primary care physician's name
Physician's phone number or clinic name
Hands-on stretching screening — check any that apply
Emergency contact name
Emergency contact phone
Please enter a valid phone number.Format: (000) 000-0000.
PAR-Q+ Result — did the official screening at eparmedx.com/par-q recommend you consult a physician before increasing your physical activity, or were you cleared to begin?
Goals & Wellness
What’s your #1 goal right now?

Other
Anything else driving that goal?
Would you like nutrition guidance included in your coaching?
Are you interested in assisted stretching services (PNF/PIR-MET manual stretching) as part of your coaching?
Have you had previous experience with assisted stretching?
Please describe what you did and did not like about your previous assisted stretching experience.
Do you prefer a quiet or conversational stretch experience?
What level of stretch intensity do you prefer?
Assisted Stretch clients only: Assisted Stretch sessions involve direct, hands-on physical contact (PNF/PIR-MET manual stretching techniques). Before your first paid stretch session, you will be asked to read and sign a separate Hands-On Manual Therapy Consent Addendum, in addition to the general Liability Waiver.
Do you currently stretch or do mobility work?
Average hours of sleep per night
Current stress level
Availability
Preferred session format
Which days generally work for you?
General time of day
How many sessions per week are you hoping for?
Best way to reach you to schedule
Anything else I should know before our first meeting?
Should be Empty:

Client Snapshot — ManlyMovement

About You

Training History & Injuries

Goals & Wellness

Availability