Repetitive ActivitiesPlease list any repetitive activities you engage in on a daily basis (e.g computer / desk-based work, lifting, driving, standing etc)
Personal Health InformationPlease give details below of any injuries, recent surgeries, traumas, illnesses or any physical limitations. All information given will remain private and will only be disclosed to your doctor if necessary.
MedicationsPlease list any medications you are taking.
ActivitiesAre there any activities you are currently unable to do easily / not at all?
ObjectivesWhat do you hope to gain from Feldenkrais classes / Individual lessons?
ReferralWere you referred by anyone?
By submitting this form you are agreeing to the following:I attest that the above information is true and correct to the best of my knowledge. I further understand my sessions with Abbe Harris / Feldenkrais Dublin are an educational process and not therapeutic in nature and that I may be required to receive medical clearance from my primary medical provider.
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