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Magda Kaczmarska Dance
New Client Intake Form
Email address *
Email address *
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Full Name *
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Address
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What is the best phone number to reach you? *
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What is your current fitness routine?
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Briefly describe your prior experience with dance or fitness (ballet, modern, jazz, pilates, yoga, other).
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What are your goals for participating in this program?
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Please list any pertinent health concerns (ie. low/high blood pressure, arthritis, spinal conditions, surgeries, etc.)
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Please list any physical issues (ie. pain/tenderness in the shoulders, low back tightness, etc.)
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Briefly describe your current day-to-day demands on your body (ie. work, stress, long-hours standing, new parent) and how you would like to feel after your session (ie. refreshed, stretched, toned). ** There are no right or wrong answers, but this gives me insight for creating an optimal experience.
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