Health Questionnaire | Ready for a Stronger, Happier You

You’re One Step Closer to Your Goals!

Before your trial session please fill out this form so I can tailor the sessions to meet your needs.

First name

Last name

Address

Phone

Birthday

Day

Month

Year

How did you find out about me?

Please describe any previous experience with fitness training, sports, or physical activity.

What are your goals/expectations? What benefits are you looking for?

Are you recovering from an injury or illness / challenged by specific limitations or chronic pain?

Are there any movements or activities you're currently avoiding?

Are you pregnant or have recently giving birth?

Are you currently taking any medication?

Is there anything else important you would like to tell me?

I sometimes share little moments from sessions on Instagram. Would you be okay with being included in these clips now and then? If you’d like to be tagged, feel free to share your profile name

How would you prefer to get the invoice?

Mail

I’m joining the training at my own risk, understand that Valeria Künzli isn’t liable for any injuries, and I’ve read and agree to the terms and conditions. https://www.valeriakuenzli.com/terms-and-conditions

I confirm that the information given is true and complete.

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

If you have supplementary insurance, please fill in the following details for confirmation

Insurance Name

Insurance Typ

Insurance Number

You’re One Step Closer to Your Goals!

5.0 Google Ranking

Imprint

Terms and Conditions

recognized by health insurance