Client Intake Form Template for Posture Correction & Ergonomics

Use in FirstRep form

Personal Information

Collecting personal details helps tailor the posture correction program to individual needs.

Aa Name *

Enter your full name

Aa Email *

Enter your email address

# Age *

Enter your age

Posture Assessment

Understanding your current posture is crucial for effective correction strategies.

v How often do you experience discomfort due to poor posture? *

... Describe your posture challenges *

E.g., rounded shoulders, tech neck

1-10 Rate your current posture on a scale of 1-10 *

1 being poor, 10 being excellent

Work Environment

Identifying your workspace setup is essential for ergonomic adjustments.

v What type of desk do you use? *

# How many hours do you spend at your desk daily? *

Enter hours

Y/N Do you use ergonomic chairs or accessories? *

Lifestyle and Habits

Lifestyle factors can greatly influence posture and ergonomics.

Y/N Do you engage in regular physical activity? *

... What types of exercises do you currently do?

E.g., yoga, weightlifting

v How often do you take breaks during work? *

Goals for Posture Correction

Setting clear goals helps track progress and maintain motivation.

... What are your primary goals for posture correction? *

E.g., reduce pain, improve appearance

v How soon do you want to see improvements? *

Y/N Are you willing to commit to daily exercises? *

Why Use This Template

Identify specific posture issues.

By understanding your challenges, we can create a tailored plan.

Track progress over time.

Regular assessments will help you stay motivated and accountable.

How to Use

Fill out each section accurately to ensure a personalized approach.

Review your responses with your coach to set actionable goals.

Customization Tips

Use client testimonials to personalize the form.
Add images or diagrams to illustrate posture issues.
Incorporate a progress tracking section for ongoing assessments.

Build and send posture correction & ergonomics templates digitally with FirstRep. Free for up to 3 clients.

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Frequently Asked Questions

How long will it take to see improvements in my posture?

Visible improvements can take a few weeks to months depending on consistency with exercises and lifestyle changes.

What if I struggle to maintain good posture at work?

Regular reminders and ergonomic adjustments can help, along with consistent practice of corrective exercises.