Client Intake Form

Please complete this confidential intake form before your scheduled Flex Mobile Stretch session. The information you provide helps us understand your wellness goals and prepare for a safe, personalized session.

Wellness Stretch Program

Clinical Intake & Contact Form

First Name*

Last Name*

Email Address*

Phone Number*

Date of Birth*

Month

Day

Year

Gender Identity

Female

Male

Non-binary

Prefer not to say

Mailing Address

Patient Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Primary Wellness Goals*

Please describe what you hope to achieve through our stretch program.

Areas of Focus

Lower Back

Neck

Hips

Hamstrings

Upper Back

Full Body

Other

Have you participated in a professional stretch program before?*

Yes

Patient Consent Signature*

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By signing, you confirm that the information provided is accurate and you consent to clinical evaluation.

I would like to receive wellness tips and program updates via email.

Recommended Stretching & Recovery Products

Simple tools to support flexibility, mobility, posture, and recovery between assisted stretching sessions.

As an Amazon Associate, Flex Mobile Stretch LC earns from qualifying purchases.

Stretch Strap

A durable non-elastic strap help to achieve deeper stretches and longer holds with better control.

Foam Roller

High-density foam for myofascial release, helping to soothe muscle tension and improve blood flow.

Resistance Band Set

Versatile bands for mobility work and strengthening key postural muscles between sessions.

Massage Ball

Targeted trigger point therapy for hard-to-reach areas like the glutes, shoulders, and feet.

Lumbar Support Cushion

Designed to support the natural curve of your spine and improve posture during long sitting periods.

Product recommendations are for general wellness and educational purposes only. Always use products safely and consult a qualified healthcare provider if you have pain, injury, surgery history, or medical conditions.

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