Section 1 of 2
PhysioQinesis - Sports Specific Testing For Athletes
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Are you..
Are you..
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An Athlete
Non-athlete/Recreational Player
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What sport do you play and at what level?
(Rankings, Competitions and Achievements, etc.)
What sport do you play and at what level?
(Rankings, Competitions and Achievements, etc.)
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Tell us about your training history if you have any?
(No. of years, type of training and number of training hours per week)
Tell us about your training history if you have any?
(No. of years, type of training and number of training hours per week)
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Are you associated with any club or academy? If yes, please specify the name.
Are you associated with any club or academy? If yes, please specify the name.
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Do you have a technical coach? If yes, who?
Do you have a technical coach? If yes, who?
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Medical/Injury History?
(We'd appreciate it if you could give as many details as you can?
Medical/Injury History?
(We'd appreciate it if you could give as many details as you can?
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Do you consult with a Nutritionist? If yes, who? If no, would you be interested in consulting our Nutritionist?
Do you consult with a Nutritionist? If yes, who? If no, would you be interested in consulting our Nutritionist?
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What all areas do you want to work on?
What all areas do you want to work on?
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Strength
Power
Speed
Endurance
Agility
Recovery
Confused?Our assessment will help you decide!
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Everything starts with us conducting a thorough assessment for you! Choose yours:
Everything starts with us conducting a thorough assessment for you! Choose yours:
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Movement screening analysis with report
Musculoskeletal assessment with report
Sports specific testing
All of the above
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You would like a consultation for:
You would like a consultation for:
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Rehabilitation (Injury Related)
Sports specific training
Nutrition
Sports Massage
Yogasana
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Choice of service
Choice of service
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Personalised Training (one on one training)
Semi personalised (Group of 2-4 people)
Home Workout Program(only Program) (3-4 weeks)
Online training
Sports Massage
Nutrition
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How many times a week would you like to workout?
How many times a week would you like to workout?
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2 times/week
3 times/week
5 times/week
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Are you currently taking any medications?
Are you currently taking any medications?
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Have you had COVID and been vaccinated in the last 2-3 months?
Have you had COVID and been vaccinated in the last 2-3 months?
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Yes,I got Covid and am vaccinated
Yes,I am vaccinated
None of the above
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Section 2 of 2
Consent Form
I, the undersigned, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in physical activity. Having such knowledge, I hereby acknowledge that this releases, any representatives, from liability for accidental injury, illness and/or death, which may incur as a result of participating in the physical activity at Physioqinesis.
I hereby assume all risks connected therewith and consent to participate in PhysioQinesis fitness program. I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in the above program. I agree to utilize the session before the validity date. In case of Emergency or sickness I agree to inform the respective coach & email at Frontdesk@physioqinesis.com 24 hours prior to the appointment.
Failing to do so will be considered as utilization of that particular session. In case of a planned travel, I will inform it at least 7 days prior to the same. Failing to do so will be considered as utilization of the number of sessions missed during travel.
I, the concerned/authorised person do hereby accept all the terms and conditions present in the consent and waiver form.
I, the concerned/authorised person do hereby accept all the terms and conditions present in the consent and waiver form.
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I accept
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