Application for the
MOVE
away from pain programme
Your details
Please answer the questions below to help me understand if you are the right fit for the
MOVE
away from pain
programme.
OK
*
1.
Name
(Required.)
*
2.
Mobile phone number
(Required.)
*
3.
Email address
(Required.)
*
4.
Postal address and postcode
(Required.)
5.
DOB:
6.
Please describe the current state of your physical health and any issues you are experiencing
7.
Please explain how long you have been dealing with any existing injuries or physical conditions
8.
What are your reasons for wanting to do the
MOVE
away from pain
programme
Manage arthritis
Ease aches and pains
Release tension in the body
Increase flexibility/range of movement
Tone the body
Improve posture
Feel more energised
Move more freely in daily life
Sleep better
Feel calmer and more relaxed
Accountability to stay active
Other (please describe)
9.
Please add any further comments about what you are seeking to gain from the
MOVE
away from pain
programme
10.
Where did you hear about the
MOVE
away from pain
programme?
Current Progress,
0 of 10 answered
