Posture Questionnaire
What is your name? *
Your answer
What prompted your interest in posture?
Your answer
Do you experience any areas of pain or discomfort? If so, where?
Your answer
What do you currently do to maintain your wellness? (ie exercise and diet)
Your answer
What do you currently do to maintain or improve your posture?
Your answer
What do you feel are your main postural issues?
Your answer
Do you experience any of the following:
In your ideal world what are three things you would like to achieve in terms of your health and wellness in the short term (by end of summer)?
Your answer
In your ideal world what are three things you would like to achieve in terms of your health and wellness in the longer term (by the end of the year)?
Your answer
What is the best time to for me to reach you by phone?
What is your date of birth?
MM
/
DD
/
YYYY
What is your gender?
What is the best number for me to call you on?
Your answer
What is your email address? *
Your answer
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