New clients: complete your intake before your first assisted-stretching session.

P.R.I.M.E STRETCH

New Client Intake Packet

Please complete all applicable fields before your first assisted-stretching session. Your answers help tailor sessions to your goals, current limitations, and comfort.

Prefer to complete it by hand?Download the 4-page PDF packet

1. Client Information

2. Health History

Have you ever been diagnosed with any of the following? Check all that apply.

3. Mobility & Flexibility Assessment

Primary goals & concerns

What brings you in today? Check all that apply.

Areas of tightness / restriction

Current symptoms & activity

Rate your overall flexibility (1 = very poor, 10 = excellent).

Rate your pain today (0 = no pain, 10 = worst pain).

4. Lifestyle & Session Information

5. Client Acknowledgment & Consent

Client acknowledgment: I certify that the information I have provided is accurate and complete to the best of my knowledge. I understand that I should update P.R.I.M.E Stretch if my health status, medications, injuries, or physical limitations change.

Assisted stretching consent: I understand that assisted stretching is a wellness and mobility service intended to support flexibility, range of motion, movement quality, and general physical well-being. I understand it is not medical treatment, physical therapy, chiropractic care, diagnosis, or a substitute for care from a licensed healthcare professional.

I understand that physical activity and assisted stretching may involve risks, including temporary soreness, discomfort, muscle strain, joint irritation, dizziness, or other injury. I agree to communicate immediately if I experience pain, numbness, dizziness, or discomfort.

I understand that P.R.I.M.E Stretch may modify, pause, or discontinue a session when information provided by me or my physical response indicates that a movement may be inappropriate. I have disclosed relevant medical conditions, medications, injuries, surgeries, limitations, and symptoms to the best of my knowledge.

I voluntarily choose to participate in assisted stretching and acknowledge the inherent risks associated with physical movement. To the extent permitted by applicable law, I agree to release and hold harmless P.R.I.M.E Stretch and its practitioner from claims arising from my participation, except to the extent caused by gross negligence or willful misconduct.

Communication consent

I agree to receive appointment-related communications by:

Photo / testimonial consent

Marketing use requires separate, voluntary permission and will not affect your ability to receive services.

This form contains health-related information. P.R.I.M.E Stretch is a wellness service, not a medical provider. Website form submissions are processed through Netlify Forms. If healthcare-regulated record handling is required, use a compliant platform.