Balanced Motion Pilates and Yoga, fitness centers in New Liskeard Ontario
What's New at Balance Motion Balanced Motion Pilates and Yoga, fitness centers in New Liskeard Ontario Register with Balanced Motion Pilates and Yoga New Clients with Balanced Motion Pilates and Yoga About Balanced Motion Contact Balanced Motion Pilates and Yoga, fitness centers in New Liskeard Ontario FAQS for Balanced Motion Pilates and Yoga, fitness centers in Temiskaming Shores Ontario
Balanced Motion Pilates and Yoga, fitness centers in New Liskeard Ontario
Balanced Motion Pilates and Yoga, fitness centers in New Liskeard Ontario

Register with Balanced Motion Pilates and Yoga

Printable Registration form here or submit online below.

 
 
 
 




Arthritis Hernia
Asthma/breathing problems High blood pressure
Cigarette smoking Kidney/ bladder
Diabetes Menopause
Digestive problems / colitis / diarrhea Osteoporosis
Eye problems / glaucoma / detached retina PMS
Fatigue / sleep disorders Pregnant - Due date:
Hearing / ear problems Recent surgery
Heart condition Thyroid
IBS Other?:


Numbness / pain in:

Neck Shoulders Elbows Hands Wrists Hips Lower Back Upper Back
 
Knees Ankles Feet Other?:

Symptoms:


History:

Back injury Motor vehicle accident Bladder control issues
Chronic or recurrent back pain or SI joint pain Severe episode or back pain/sciatica


** An assessment may be required **

Is there any other reason why you should limit your physical activity? (ie. Other medication, physical conditions):

 
Are you currently being treated for any of these conditions?:
 
By Whom?
 
Physician Physiotherapist Chiropractor Naturopath
 
Massage Therapist Other, please specify:
 
Name of Practitioner:
 
Please list any prescribed medication you are taking on a regular basis, its purpose and how it affects you.
 
active options
Yes, I agree to the above.
 
 
Balanced Motion Pilates and Yoga, fitness centers in New Liskeard Ontario