Client Questionnaire

Please fill out this questionnaire before your first class or session with me! Many thanks.

Full Name*

Email*

Address*

Next of kin

Phone*

Please describe your current difficulties related to movement and wellbeing. (such as not being able to walk for longer than x time, exhausting quickly, pain after exercise, sleep quality, etc)*

Please list any surgeries or past injuries that might still impact you in your daily live*

Any questions about Somatic Movement before I see you?