Movement History Form
Use this form to begin your Movement Analysis. After I receive your completed form, I will contact you within 72 hours to schedule your free 30-minute analysis.

Movement Optimization begins with a detailed analysis of your unconscious movement habit patterns. During your analysis, I will review your movement history and analyze your movements.

Then, I'll will create a personalized movement plan that includes hands-on neuromuscular repatterning and Essential Movements that you'll practice at home.
Email address *
Name *
Your answer
Phone Number *
Your answer
Your Age *
Your answer
Briefly describe the movements you want to optimize (i.e. sport, musical instrument, job-skill, etc.). *
Your answer
Briefly describe the limitations you are encountering.
Your answer
How frequently do you practice your skill? *
Per week
Briefly describe any injuries you've had in the past.
Your answer
Briefly describe any physical discomfort you are feeling now.
Your answer
Movement Optimization may require changes to your training routine, diet, stress management, and exercise, and may include a period of time when your performance declines. How willing are you to make substantive changes where necessary? *
Totally enthusiastic
How did you find out about Middleway Method *
Please use the space below to ask questions and share important information that was not covered in this questionnaire:
Your answer
A copy of your responses will be emailed to the address you provided.
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