Dani Lieberman

Client Forms

 

All clients are required to fill out the form below before their first session. Anyone who has been under a physician’s or a physical therapist’s care within the past 12 months will also need to obtain a signed physician’s release from your doctor stipulating any directives regarding movement programming and/or any limitations that should be honored within your training program.

Name *
Name
select "yes" if you've experience any of these health conditions over the past year.
Hypertension *
Pregnancy *
Broken Bones *
Osteoporosis *
Weight Gain *
Weight Loss *
Heart Disease *
Surgery *
write "none" if you haven't had any.
write "none" if you aren't on any medication.
If this does not apply, write "no"
If not, write "no"
Medical Waiver & Release - Please Initial
Cancellation Policy
 


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