What age bracket describes you?
18-2526-4040-5050-65Older than 65I am a parent inquiring about treatment for a child who is a minor.

I have had surgery:
YesNo

If so, what surgery did you have?

I am scheduled for surgery and would like to start preparing for surgery through exercise under supervision of a licensed therapist:
YesNo

If so, what surgery are you having and when?

I have had a recent injury:
YesNo

If so, what body part?

I currently am experiencing pain:
YesNo

If so, what body part(pain)?

I am looking for advice to prevent injury:
YesNo

If so, what body part(prevent injury)?

I am looking to incorporate exercises monitored by a licensed therapist to manage a newly diagnosed or chronic condition:
YesNo

If so, what condition?

I have been diagnosed with a movement disorder and my doctor has recommended therapy to help manage my condition:
YesNo

If so, what movement disorder?

How would you describe your activity level?
I am overall a sedentary person who does not exerciseI exercise 1-2 days per week (minimum 30 minutes of exercise/day)I exercise 3-5 days per week (minimum 30 minutes of exercise/day)I exercise 5-7 days per week (minimum 30 minutes of exercise/day)

Do you have access to a computer or mobile device, as well as secure internet access, that would allow you to have a video conference with a licensed therapist?
YesNo