PostureFit enrolment form

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Name

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Date of birth

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Address Street and number

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Address Town

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Address Postcode

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Email

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Mobile

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Height, weight and shoe size

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Current injuries/issues

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What treatment have you receive previously for this?

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Typical physical activities – work, sport, recreation?

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Please give details of any other medical conditions or medication that you feel your practitioner should be aware of.

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What outcome would you like to achieve from a PostureFit consultation and treatment?

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I understand I am supplying PostureFit with images, personal information, physical injuries, and physical history information for the benefit of my consultation and treatment.
I understand that I should NOT attend my face to face appointment in the event that I am suffering flu like symptoms.
For online consultations - I will ensure I am in a safe environment free from hazards.
I am aware that PostureFit will store my personal data for medical records purposes.
I acknowledge that PostureFit Ltd may charge a fee equivalent to 50% of the appointment cost if I fail to cancel or reschedule my appointment with less than 24 hours’ notice prior to the original booking time.

I agree with these statements