Client Enquiry Form

Client Enquiry Form

Thank you for your interest in training with FP Human Biomechanics Specialist Mark Labib. This form helps me understand your current situation, training history, goals, injuries and any relevant health considerations before we begin. Please answer each question as accurately and specifically as possible. If you are unsure about any question, you can leave a note and we can discuss it during your initial consultation. Please note: I accept clients using NDIS, WorkCover and DVA funding.
Section 1 - Your Details:
Full Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Date Of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Emergency contact name
Emergency contact number
Format: (000) 000-0000.
What is your home suburb?
What is your occupation?
Which is your preference for training?
Section 2 - Injury & History Training:
Please provide a brief history of previous injury and treatment.
Are you currently in any pain or discomfort? If yes, please elaborate on the nature of your pain. Please provide a pain score out of 10 of your pain with each region (0 being no pain, 10 being the worst pain)
Which activities or movements tend to aggravate your symptoms?
What, if anything, helps reduce your symtoms?
Please provide a brief summary of your current exercise regime, if any.
Do you have any relevant reports, x-rays, or any other medical imaging scans you'd like to show us? If yes, please upload them below

Cancelof
Section 3 - Nutrition and Lifestyle:
How would you describe your current diet?
How frequently do you consume grains or grain-based foods? (e.g. breads, pasta, cereal, oats, rice)
How frequently do you consume caffeine?
How would you describe your alcohol consumption?
Is there anything about your current diet or lifestyle that you feel may be affecting your energy, recovery, sleep or training?
Please briefly describe your sleep hygiene. Include roughly your bed/wake-up times, duration of sleep and the quality of your sleep.
How would you describe your current approach to getting regular sunlight?
Lifestyle preferences. Please tick the following that apply

Other
Section 4 - Goals
What are your main goals from doing Functional Patterns?
What would a successful outcome from training look like for you?
Is there anything specific that you'd like to be able to do that you're currently struggling with?
Section 5 - Medical Clearance
Medical Conditions: Do any of the following apply to you?
Please explain any checked items from above
Medical Conditions: Please tick the following that apply
Please explain any checked items from above
Please watch both videos before your assessment. You can click on the YouTube videos to open them and save them for later if needed. The video links will also be included in the confirmation email you receive after submitting the form.

This will help you understand more about Functional Patterns and ensure more time can be spent analysing your biomechanics during the consult.

Thank you.
Video 1
Video 2
Section 6 - Availability and Consent
What are your best days and times to train?
How did you hear about me and or Functional Patterns?
Would you be comfortable appearing in photographs or videos taken during training for educational or promotional purposes? (I will always consult you before publishing any content and discuss the option to anonymise your identity)
Cancellation Policy: Appointments are reserved specifically for you. If you need to cancel or reschedule an appointment, I require a minimum of 24 hours' notice. Cancellations or missed appointments with less than 24 hours' notice may incur the full session fee. Exceptions may be made for genuine emergencies or circumstances outside your reasonable control. By submitting this form, you acknowledge and agree to this cancellation and rescheduling policy.*
Wavier: I understand that participation in physical exercise involves inherent risks, including the possibility of injury. I confirm that the information I have provided in this form is accurate and complete to the best of my knowledge. I understand that I should inform Mark of any changes to my health, injuries, medications or other circumstances that may affect my ability to participate in exercise. I understand that the training provided is exercise and movement coaching and is not a substitute for medical diagnosis, medical treatment or advice from an appropriately qualified health professional. Where appropriate, I understand that I may be advised to seek assessment or clearance from a medical or allied health professional before continuing with certain activities.”
I confirm that the information I have provided in this form is accurate and complete to the best of my knowledge. I understand that it is my responsibility to inform Mark of any relevant changes to my health, injuries, medications or circumstances that may affect my participation in exercise. I have had the opportunity to ask questions about the information requested in this form and understand that my responses will be used to help inform my training and exercise program.
Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty:

Client Enquiry Form

Section 4 - Goals

Section 5 - Medical Clearance

Section 6 - Availability and Consent