Application for the MOVE away from pain programme

Your details

Please answer the questions below to help me understand if you are the right fit for the MOVE away from pain programme.

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* 1. Name

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* 2. Mobile phone number

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* 3. Email address

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* 4. Postal address and postcode

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* 5. DOB:

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* 6. Please describe the current state of your physical health and any issues you are experiencing

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* 7. Please explain how long you have been dealing with any existing injuries or physical conditions

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* 8. What are your reasons for wanting to do the MOVE away from pain programme

Manage arthritis

Ease aches and pains

Release tension in the body

Increase flexibility/range of movement

Tone the body

Improve posture

Feel more energised

Move more freely in daily life

Sleep better

Feel calmer and more relaxed

Accountability to stay active

Other (please describe)

Application for the MOVE away from pain programme

Your details

Question Title

* 1. Name

Question Title

* 2. Mobile phone number

Question Title

* 3. Email address

Question Title

* 4. Postal address and postcode

Question Title

* 5. DOB:

Question Title

* 6. Please describe the current state of your physical health and any issues you are experiencing

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* 7. Please explain how long you have been dealing with any existing injuries or physical conditions

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* 8. What are your reasons for wanting to do the MOVE away from pain programme

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* 9. Please add any further comments about what you are seeking to gain from the MOVE away from pain programme

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* 10. Where did you hear about the MOVE away from pain programme?