Movement Integration - Client Registration
Please use this form to answer questions about your current fitness levels and your future desires for yourself and your health. If you have any questions or concerns, please email
First Name *
Last Name *
Email Address *
Is it okay to send you emails for promotional purposes? *
Cel Phone Number *
Is it okay to send you group text messaging for promotional purposes? *
Name of your Movement Integration Specialist *
What is your primary reason for seeking Personal Movement Integration? *
Please check any areas of injury or sensitivity. *
Please check all activities that bring you discomfort. *
Mark all the ways you enjoy moving. *
Mark any ways of moving that make you truly uncomfortable. These are movements we will stay away from. *
What is your favorite genre of dance to watch? *
What is your favorite genre of dance to do? *
What style of music to you prefer? *
Are explicit lyrics okay with you? *
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