New Client Intake Form

Please complete the form below prior to your first session:

Name:(required)

Email:(required)

Address:(required)

Phone Number:(required)

Emergency Contact name, Phone Number, and relationship:(required)

If you will take any online movement lesson at a different address, please list it here

How did you find out about me?(required)

Main reason for desiring Feldenkrais lessons?(required)

If you have a main (movement) complaint how long has it been going on? What have you done to address it up until now?

List any surgeries, hospitalisations or medical conditions:(required)

List any positions or movements that cause pain, or you have been instructed not to do by a medical professional:(required)

What does your current situation stop you doing that you would like to do?

What activities bring you joy?