Client Intake

Help Us Prepare for Your Treatment

Please take a few minutes to complete this form before your first treatment so your session can be tailored to your needs.

Share only information that is relevant to your treatment. Any sensitive details you would prefer not to enter online can be discussed privately during your appointment.

Sports Therapy Client Intake Form

Full Name *

Please enter your full name.

This field is required.

Email Address *

We’ll use this to contact you regarding your therapy sessions.

This field is required.

Phone Number *

Please enter a contact phone number.

This field is required.

Gender *
Select your gender identity.

This field is required.

Emergency Contact Name
Name of a person to contact in emergencies.

This field is required.

Emergency Contact Phone Number
Phone number of the emergency contact.

This field is required.

Current Injuries or Conditions *

Please describe any injuries or medical conditions related to your therapy.

This field is required.

Previous Treatments Received
List any previous treatments you have received for your condition.

Goals for Therapy *

What goals do you hope to achieve through therapy?

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How did you hear about us? *

Please select how you found out about our services.

Friend/Family

Social Media

Online Search

Other

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GDPR Compliance *

Please indicate if you consent to data processing.
This field is required.