Consult Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out the following short answer questions so Threaded Kinetic can better serve your needs.

Are you currently injured and seeking physical therapy, healing from surgery, or otherwise not cleared for physical activity? *

Not Injured - Please Continue

Yes I'm Injured- Stop here and contact us again when you have been cleared for physical activity by your Physician.

First name? *

Last name? *

Email address ? *

Phone number? *

Year of birth? *

What city do you live in? *

What state is that in? (WA,OR,CA...etc.) *

If present, simply explain your chronic conditions that you would like help with. *

Select all that apply to your goals for working together. *

Exercise Therapy for Diabetes - Type- 1, Type- 1.5, Type- 2, & Type- 3

Stress Redux

Lose Weight

Diet Quality Control

Motivational Coaching

Reduce Blood Pressure

Improve Insulin Sensitivity

Gratitude & Mindfulness Training

Improve Cognitive Function

Extend Spatial Awareness

Improve Body Mechanics

High-Impact Interval Training

Low-Impact Interval Training

Advanced Strength Training

Basic Strength Training

Rope Flow

Improve Mobility / Flexibility

Strengthening Joints

Build Back Muscle And Bone Density

Increasing Energy

Living Longer

Other:

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report