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CRC LPF 6-week series application
Low Pressure Fitness Training Post-Concussion
. This series is sponsored by the Concussion Resource Center and FREE to individuals who have sustained concussion.
FRIDAYS 10 - 11 am
FEB 2 - MAR 8, 2024
at Bozeman Fire Station 3
(next to the Dino Park)
To register, complete the application below. The course facilitator, Turi Hetherington, will contact you to confirm. Watch for an email coming from turihetherington@gmail.com
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Name:
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Your answer
e-mail address
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Your answer
Cell phone (for text reminders)
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Your answer
How did you hear about this series?
*
Concussion Resource Center
Poster
Facebook
Friend
Other:
Can you attend all 6 session?
Yes
No
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Have you had a concussion or are you a caregiver for someone who has?
*
Your answer
If you have had a concussion, how many and when?
Your answer
What persistent symptoms are you experiencing such as headache, dizziness, neck pain, visual changes? Please list all.
Your answer
How often do these symptoms occur? Are there specific triggers we should be aware of?
Your answer
What is your current level of physical activity?
Your answer
What are your goals for participating in this series?
Your answer
Following is a list of possible contraindications for the practice of LPF. Please check any that apply.
Hypertension
Abdominal surgery within the last 3 months
Cardiopathy
Glaucoma
Acute pain or inflammation
Pessary IUD
Do you have any questions, comments or concerns you'd like to share?
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