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New Client Intake.

8 Questions to help us learn a little more about you, your pain problem and your goals.  

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Question 1 of 8

In a few short sentences can you tell us a little about your pain problem, where it is in the body and when and how you think it started?

Question 2 of 8

What other things have you tried to solve this particular issue? 

(Select all that apply)
A

Visited my doctor or other specialist

B

Physical Therapy

C

Chiropractic

D

Massage

E

Pain Medications

F

Alternative Medicine

G

Nothing yet.

Question 3 of 8

What makes it better? 

What makes it worse? 

Question 4 of 8

Is there something specific you think will help you feel better? 

(Select all that apply)
A

A thorough movement assessment to find out where the pain is coming from

B

Hands on, manual therapy

C

Dry Needling

D

Cupping

E

Joint Manipulation (Cracking)

F

One on One Coaching / Personal Training for Strength and Flexibility.

G

Online exercise videos for an online or home exercise program.

H

I need / want it all !!!

I

You're the expert, you tell me.

Question 5 of 8

What your goals in working with us? 

What do you want to accomplish and why?  Why is now the time you are seeking help?  

Question 6 of 8

When are you looking to get started? 

Question 7 of 8

Do you have a preferred location? 

(Select all that apply)
A

Hudson, OH. (Inside CrossFit Cadre)

B

Beachwood, OH. (Inside InMotion)

C

Cleveland, OH. (Inside CrossFit CLE)

D

Fairview Park, OH. (Inside Ctown Fitness West)

Question 8 of 8

How did you hear about us? 

(Select all that apply)
A

Friend

B

Medical Professional Referral

C

Google Search

D

Instagram / Facebook

E

YouTube

F

The PHYT For Tomorrow Podcast

G

Other

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