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Body & Brain Check-Up

Record the number of points after each exercise to evaluate your condition

Name*

Email Address*

Phone:

I prefer to be contacted by:
1. Flexibility Check I (Basic Stretching)
2. Flexibility Check II (Arms & Wrist twist and stretch)
3. Balance Check (standing on one leg)
4. Coordination Check I (fist tap / palm sweep on each side of your chest)
5. Coordination Check II (thumb out on one fist & pinkie our on the other fist and alternate)
6. Strength Check (squats bending your knees 90 degrees and arms out parallel to the floor)
7. Endurance Check (flying eagle pose)
8. Physical Power (Check all that apply)
9. Mind Power (Check all that apply)
10. Brain Power (Check all that apply)
11. What is your goal of training? (Check all that apply)

Describe Other:

Date:*

Thank you for completing Body & Brain Checkup form. We look forward to supporting you in your healing journey! Namaste, Holistic Healing & Yoga

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