New client information
Aloha and welcome to Wainani Wellness Center!  We would love to get to know you better!  Please complete this form and we will get back to you within 48 hours.
Email *
Name (First, Last) *
Phone number *
Age *
What services are you interested in?  (Check all that apply) *
Required
What method/modality are you interested in? (Check all that apply) *
Required
Are you recovering from a recent injury or surgery? If yes, please elaborate. *
If you are in pain, on a scale of 0-10, what is your level of pain? *
No Pain
Extreme Pain
What are your primary fitness goals? (ie. Core, Flexibility, Strength, relieve low back pain, knee pain, etc.) *
What days are you available? (Choose all that apply) *
Required
What is your availability? (Choose all that apply) *
Required
Are you looking to work with a specific instructor or are you open to working with any/all instructors? *
Have you had previous Pilates/Gyrotonic experience? Or are you new to these methods?
Are you being referred by another client or your doctor? If so, who referred you or how did you hear about us? *
What other exercise activities do you do during the week?
Is there anything else you would like to share with us? *
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