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Name*







Your username defaults to your email address, but you can change this to something else.
You will always be able to use your email address on file to login.

Gender*





Birth Date*

YYYY/MM/DD






Please select any injured or dysfunctional areas of your body that limit you from performing physical activity or exercise:

Please select all areas that apply














Ankles

Which side?







Knees

Which side?







Hips

Which side?







Shoulders

Which side?







Arms

Which side?







Hands

Which side?







Spine / Head

Exercise

What exercise methods do you use?













1 day a week2 – 3 days a week4 + days a week1 day a week2 – 3 days a week4 + days a week1 day a week2 – 3 days a week4 + days a week1 day a week2 – 3 days a week4 + days a week1 day a week2 – 3 days a week4 + days a week 1 day a week2 – 3 days a week4 + days a week

Recreational Physical Activity

Please select any recreational physical activity you engage in:























1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year 1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year 1 – 5 times a year5 – 10 times a year10 – 20 times a year20+ times a year