Let’s work together Fill in the questionnaire bellow and we’ll get back to you shortly Open Form Contact Form Name * First Name Last Name Email * Phone (###) ### #### Where did you hear about us? What is your occupation? Please tell us your age Do you have injuries / are you currently experiencing pain? If your answer is Yes, please elaborate On a scale of 1-10, what is your pain level most days? 1 2 3 4 5 6 7 8 9 10 Please detail any therapy/interventions/ medication you have received to help deal with the pain/ injuries you described What forms of exercise/therapy/recreational sports or other activities do you currently engage in? Please include any relevant exercise and movement history even if you are currently not active How willing are you to implement the Movement Elimination Protocol (video in the Getting Started Section) and stop these activities during your recovery/while initially learning and applying Functional Patterns concepts in your life? Choose an option between 1-5, where 1 is completely unwilling and 5 is very willing 1 2 3 4 5 Have you started the 10 Week Online Course We recommend starting the 10 week course because it will help you grasp the essential foundations of the FP methodology, which will enable you to better understand the concepts your practitioner refers to in your sessions Is there anything else you would like us to know before we contact you? * Thank you! We’ll get back to you as soon as possible
