Intake Form - Mobility
Questionnaire for Mobility clients looking to work with Lisa Kitagawa.

You will be contacted following the completion of the questionnaire for further steps.

Please note that all information in this document is confidential and will not be shared. 
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Email *
Name (Full + a preferred name if applicable) *
Instagram and/or relevant social media handles *
Age and Birth year
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Are you looking for 1:1 customized programming/coaching or a general mobility program?
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Short Term Goals (6 months to 1 year)
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Long Term Goals (Over 1 year)
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How long have you been training for?
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Training Level
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What is your current sport/style of training?
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How many hours per week do you perform resistance/lifting type training?
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How many hours per week do you do Cardio/HIIT type training?
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Do you participate in other sports/activities? 
(Include hours/intensity involved)
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How many days can you commit to mobility training?
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Any current struggles/injuries, nagging/chronic pain or health issues?
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What is your occupation and the level of intensive labour required in it?
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What mobility program(s) have you run in the past and your experience(s) with them?
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What qualities or character traits are you looking for in a coach/trainer?
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Are there any exercises/movements that you cannot perform? If yes, describe.
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What are your favourite exercises?
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Please note any relevant information that was not covered above, or use the space for questions or concerns you might have.
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Are you interested in adding/learning about any other services at the moment? (Discounts on additional services/bundles available!)
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Required
By clicking yes, you understand and agree that coaching services and programs provided by us are the intellectual property of Lift With Lisa (Lisa Kitagawa). Any unauthorized use or redistribution of any intellectual property provided by us will result in termination from our coaching services and a claim for infringement. The use of any Performance Enhancing Drugs (PEDs) or any WADA banned substance while training for, competing or intending to compete in a drug tested federation will result in the termination of our coaching services. Failure to make a payment for services following invoicing will result in the termination of our coaching services.
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By clicking yes, you are aware and able to commit to an initial 3 month contract.  Whereafter, the service will roll into a month-to-month contract which can be terminated at any time without any cancelation fees.
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By clicking yes, you recognize that it is your responsibility to work directly with your health care provider before, during, and after seeking nutrition and / or fitness consultation.
Any information provided is not to be followed without prior approval of your doctor. If you choose to use this information without such approval, you agree to accept full responsibility for your decision.
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A copy of your responses will be emailed to the address you provided.
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