We are excited to offer you the opportunity to apply for a Complimentary Healthy Movement Habits Strategy Session. Discover what your biggest challenges are for a healthy, active, pain-free life, and what you can do to take control of your mind, body, and movement habits to achieve wellness success. We have a limited number of appointments available and request that only serious applicants apply. If you are ready to dramatically improve your health & fitness apply now for your complimentary session. Click here to fill out this brief Health Assessment survey. The more thorough you are, the better we can serve you.

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* 1. Contact Information. (All personal information will be kept confidential and will not be shared.)

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* 2. How did you hear about the opportunity to apply for a free Healthy Movement Habits Strategy Session with Aliesa George, PMA-CPT?

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* 3. On a scale from 1-5 are you currently experiencing any pain that limits your ability to be active, exercise, and do everything you want in life?

  1-No Pain 2-Slight or Rare Pain 3-Moderate or Occasional Pain 4-Strong or Frequent Pain 5-Extreme or Continuous Pain
Feet
Knees
Hips
Low Back
Mid Back
Upper Back
Shoulders
Arms
Hands
Neck
Chest
Abdomen

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* 4. How might specific injuries or accidents explain why parts of your body hurt? Please briefly describe your injury and when it happened (mo./year). Have these minor or major aches, pains or injuries impacted your daily life? Have you had to stop participating in activities you enjoy? Do you have to take medications to mask the pain? How is your mental state of mind? Are you able to sleep? Have you gained or lost a significant amount of weight? Are there any other limitations, or daily life activities that are challenging for you?

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* 5. How often do you currently exercise?

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* 6. Describe the types of sports and activities you’re passionate about and LOVE to participate in for exercise to feel healthy and fit.

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* 7. What potential hurdles or roadblocks do you foresee that could get in the way of you improving your health & wellness?

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* 8. If you were to have support from Aliesa, how motivated are you to find a way to overcome these hurdles?

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* 9. Describe how you would look, feel, and how your life would improve with healthy movement habits and better whole-body health. (How will you look? How will you feel? What types of activities will you enjoy? What things that you can’t do now will you be doing easily?)

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