Intake FormPlease fill the intake form below Name * First Name Last Name Email Address * Birthdate * MM DD YYYY Why do you want to join The Online School of Exercise? * Posture Check if the misalignment applies to your posture No postural misalignment Forward Falling Head Tilted Head Slumped Shoulders One shoulder is higher than the other Spinal Deviation (scoliosis) Internally Rotated Hips One hip is higher than the other Knees project inward Knees project backward Flat Feet Other feet issues Whole body leans forward Whole body leans backward Other Do you play any sports? Please specify Workout Space * Gym Home Outside Hotel Other (Please specify) Other Workout Space Skip if you answered already Available Equipment Please specify if you do not go to a fully equipped gym Exercise Experience * None Beginner Intermediate Advanced Elite Athlete When was the last time you exercised? * Recently This month This year Over a year ago Over 5 years ago Over 10 years ago Never Chronic Pain Do you live with pain in the following areas: Insomnia Headaches/Migraines Neck Shoulders Elbows Wrists Hands Shoulder blades Lower back Hips Thighs Knees Ankles Feet Injuries Past/Present Allergies Do you have a medical condition that could put you at risk during exercise? * Yes No Please specify if you do: How many days a week can you exercise? * 1 2 3 4 5 6 7 Is there anything else you would like to share? How much did you invest in your health last year? * Just a ballpark ( Products, services, books, education, clothing, equipment, technology, etc.) No idea Less than 100$ 100-500$ 500-1000$ 1000-5000$ 5000-10000$ 10,000$ + What's your monthly health budget this year? Just a ballpark (Products, services, books, education, equipment, technology, etc.) Less than 50$/month 50-100$/month 100-300$/month 300-500$/month 500-1000$/month 1000$/month I provided all the appropriate information pertaining to my health and my exercise * Yes I acknowledge the risks pertaining to exercise * Yes Thank you! A Kinesiologist will contact you with the next set of instructions. Contact info@creavinci.com if you do not receive anything.
