Body Work Intake & Assessment Form
Share your details, current concerns, and prior movement/work history for RAS Method coaching and bodywork services.
Email address
*
example@example.com
Full name
First Name
Last Name
Age
Activity level
*
Sedentary (sit majority of the day 6+ hours, student, office worker)
Active (active job, up on feet, warehouse, nurse, delivery, sit less than 4-6 hours)
Extremely Active (personal trainer, dog walker, manual labor, 4 hours or less of sitting)
Explain the issue you are having in as much detail as possible, add any 'diagnosis' that you have been given.
Extra space if needed.
How long have you been dealing with the issue?
What procedures, surgeries, or modalities (chiropractic, acupuncture, PT, etc.) have you received?
Upload any imaging or relevant documents (X-rays, MRI reports, etc.). PDF or image files allowed.
Upload a File
Drag and drop files here
Choose a file
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What does the issue affect in life (exercise, sleep, favorite activity)?
What have you tried to alleviate the issue?
Do you have a movement practice (weightlifting, yoga, running, swimming, surfing, rock climbing) you'd like to return to?
Submit Intake Form
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