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Initial Contact Form (Please fill out with the 4th Additional Member’s Information)

Initial Contact Form MM

  • This is only applicable for those clients who purchased Family Plans
  • Please enter a number from 1 to 115.
  • If you have pain, please rate from 1-10? (1 = Absolute Worst Of All Time, 10 = Feel No Pain & I feel Amazing 24/7)
  • Rate your pain from 1 (Worst Pain of All Time) to 10 (No pain at all, feel amazing everywhere when in this position)
  • Seiza-Rocker-Position
    We will use this information when our coaches build your training program.