Intake Form
Thank you for your interest in the Feldenkrais Method at the Toenniges Center for Learning & Health. In order to make this experience the most comfortable and beneficial for you, please provide the following information.

For your lesson, please wear loose, comfortable clothing.

If you have any questions, please contact Alex Toenniges at alex.toenniges@gmail.com or (248) 821-8404.

Email address *
First name *
Your answer
Last name *
Your answer
Phone number *
Your answer
Age *
Your answer
What is your preferred gender pronoun? *
Height (approx.) *
Your answer
Weight (approx.) *
Your answer
Occupation (if retired, list former occupation) *
Your answer
Is this your first experience with the Feldenkrais Method? *
If so, have you done private lessons (FI), group classes (ATM), or both? *
Please list any injuries, past surgeries, or conditions we should know about. *
Your answer
Are you currently in discomfort or pain? If yes, please explain. *
Your answer
Are you currently taking any medications? If yes, please list. *
Your answer
Emergency contact (please list name, phone number, and relationship to contact) *
Your answer
How did you hear about us? *
Your answer
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