List and date any injury, illness, surgery or trauma (regardless of how long ago these occurred) that currently affect your mobility, pain level or ability to engage in physical activity.
Please describe your current physical condition, including any strengths and weaknesses, chronic postural or movement patterns, and recent changes.
Please describe your current movement and exercise regimen, frequency, duration, intensity, etc.
You may use this space to write in more detail about any goals and intentions you have for our work together.
You may use this this space to write in more detail about any obstacles to movement that you are experiencing.
If so, what is your smoking frequency? Would you like to quit?