Lisa Fabry Qigong & Yoga Therapy
YOGA FOR HEALTHY BONES
Client Information
GENERAL DETAILS
Today's date
Date of birth
Name
Preferred name
Email
Address
Phone number (inc country and area code)
Occupation
Health fund
Medical practitioner name and address
Emergency contact
CURRENT HEALTH
Do you have any current medically diagnosed conditions or injuries?
Have you had a bone mineral density test (DEXA scan)? If so, please email a copy of the results to lisa@lisafabry.com
Describe what physical activity you currently do: type, frequency and duration.
Describe what kind of diet you have eg omnivore, paleo, vegan.
What do you hope to gain from this course?
CURRENT MEDICATION
Please list all medication you take, including prescribed drugs, over-the-counter medicines and supplements.
For each item, please include: daily dose, reason you are taking it and how long you have been taking it.
Have you ever experienced a hypersensitivity reaction to any medication or remedy?
Do you have any known allergies or sensitivities?
Send
lisa@lisafabry.com
Get my free guide: What to Eat for Healthy Bones
Everything you need to know about nutrients for your bones and where to get them with a plant-based diet.
Name
Email
Yes! Please send it to me!