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When you wake up, do you have aches and pains anywhere on your body?

yes
no

When you go to sleep or wake up do you have stressed or negative thoughts, or a restless mind that keeps working overtime?

yes
no

Do you sit at a computer or workstation for a large part of the work day?

yes
no

Do you find that your concentration sometimes is lacking or is not what you would like it to be?

yes
no

Do you have any of these: Poor blood circulation, High blood pressure,Arthritis,Osteoporosis,Limited mobility, Lower back pain, Trouble breathing, Headaches, Tension or stress, Depression

yes
no

Do you frequently feel either too hyper or too sluggish?

yes
no

Have you had trauma of any type that has left you feeling unsafe, anxious, physically and/or mentally?

yes
no

Are you looking for a safe, relatively easy way to get fit, destress and feel better/happier?

yes
no

First and last name

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