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Aerial Evaluation Form
Full Name
*
Email (we will keep your email completely private)
Phone
*
Check any of the following conditions you currently have
*
osteoporosis
osteopenia
carpel tunnel
wrist/hand tendonitis
vertigo
motion sickness
high blood pressure
history of stroke
glaucoma
pregnancy
recent postpartum
recent surgery (last 8-12 weeks)
No medical problems listed above
A different problem explained below
Other medical problem I'm concerned about
Check any of the following problems with joints
*
neck
low back
mid back
elbow
wrist/hand/finger
ankle/toes/foot
knee
hip
shoulder
no joint problems
Would you consider yourself...
*
Very fit
Average fitness
Not fit
Do you have experience doing aerial work?
*
No, never
Yes, 1 or 2 classes
Yes, lots of classes
Yes, I've done a lot of aerial
What are you looking to get out of class?
*
A fun, new experience
A more agile body
I want my back to feel better
I want to be stronger
I want my body to change shape
More flexible
I want to be an aerial artist
Decreased stress
Better balance
I want to lose weight
Other (explain below)
What else do you want to get out of class?