How I can help you...
Please fill in this form as detailed as possible so I can learn a little more about you and how we can work together.  
Anything as big or small, as complicated or simple - you're important and I want to help you get to where you want to go. 
Looking forward to hearing more about you, your goals and how I can help you on your journey...
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A little about me with a few examples on what I can help you with...
  • Chronic or acute pain 
  • Recent surgery or mobility limitation
  • Falling or balance concerns 
  • Sporting goals? (runner? cyclist? climber? powerlifter?)
  • How to incorporate strength training along side sporting passions 
  • Help with gym confidence, lifting technique in squat, bench and deadlift 
  • Feeling more physically able and empowered 
Email: *
your email address 
Name: *
your full name 
Age *
your age 
Gender:  *
Are you currently experiencing pain when performing everyday tasks?  *
How can I help you?  *
Be as specific as possible. 
Examples:
  • Use this space to comment on your injury and / or current physical limitation / recent surgery 
  • A physical goal you may have 
  • Support or help with something in your everyday life, gym setting and / or sporting passion 
  • Falling or balance concerns 
  • Any pain or discomfort while performing your physical activity or sporting passion 
  • Concerns with ageing, age related changes and how to improve your quality of life 

What are your goals?  *
If you're unsure of a goal right now that's ok, we can work on this together.  Goals come in all shapes and sizes, you might not even be aware of them yet. 
Tell me a little about your daily routine? *
Do you work fulltime? Recent parent? Retired? 
What do you like to do to keep active, stay fit or exercise? *
This can be anything from gardening or walking to running marathons and training for a big event.  I will work with you and your needs.
If you have a fear, what would it be? Are any of these fears around movement, strength training and physical activity?  *
What are you hoping to get out of working with me? Working with Knox Physiotherapy and Coaching will be great if... *
Please complete this sentence: 
I wish I could...
 *
Have a think about your goals, your fears, where you used to be or where you want to go...
Do you use a fitness tracker or track your exercise in any way?  *
any apps, note books, previous coaching, smart watches etc 
What style of coaching and support would you prefer?  *
Thank you!
I will be in touch to book in a consult with you soon :) 
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