Aligned Fitness
Posture Therapy & Qigong

Aligned Fitness
Posture Therapy & Qigong

Client Name
Date
MM slash DD slash YYYY

Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone
Alternate Phone
Email

Sex
Height
Weight
Birthdate
MM slash DD slash YYYY

Age
Occupation
How did you find out about Aligned Fitness?
Client Info
Please describe any current pain symptoms you are experiencing as well as the results of XRay’s, MRI’s or other tests that have been performed
When does this pain symptom most often occur and what positions or activities reproduce these symptoms most frequently?
If there are any related injuries or suspicions about the origins of the problems listed above, please elaborate
List any physical activities you participate in regularly
List any physical activities, exercises or positions you are unable to perform, cause pain, or seem difficult for you
Please list any previous surgeries or medical conditions you may have
Please list any medications/herbs/vitamins that you are currently taking with an explanation of the purpose
What are the main goals you hope to achieve with Aligned Fitness?
This field is hidden when viewing the form
Notices, Acknowledgements and Representations:
Aligned Fitness is non-medical and therefore, not a medical, chiropractic or physical therapy care provider and does not perform any services requiring a physician’s or other license. Aligned Fitness, Lisa Decker, and all other contractors and/or employees of Aligned Fitness do not diagnose or treat medical conditions. Because physical exercise can be subject to risk of injury, Aligned Fitness maintains that you obtain a physical examination from a licensed medical practitioner before participating in any exercise activity. You (client) agree that if you engage in any activity or use any amenity you do so entirely at your own responsibility and risk. Any recommendations for changes in diet, supplements, or weight reduction are entirely your responsibility and you should consult a physician prior to undergoing any dietary changes. You agree that you are voluntarily participating in all activities, exercises and use of the Aligned Fitness and Addison-Pensak JCC facilities and premises and you assume all risks of injury or illness. Client understands that personal responsibility is a large component of postural therapy and personal training and therefore agrees to assume liability for any and all consequences of actions during therapy sessions and while doing exercises on own or with Aligned Fitness. I agree to inform Lisa Decker or any other employee of Aligned Fitness if any movement, exercise, or any direct physical contact feels dangerous or painful to the body. I agree to forgo the movement and not proceed further. I understand that therapeutic activities must be adjusted to physical limitations and therefore will inform Aligned Fitness of any physical limitations and will not undergo any exercise or movement I am not comfortable with. This waiver and release of liability includes without limitation all injuries which may occur regardless of negligence as a result of (a) your use of all amenities and equipment and your participation in any activity, program, exercise or instruction (b) the sudden and unforeseen malfunctioning of any equipment, fixture or device (c) any instruction, training, supervision or dietary recommendations and (d) your slipping and/or falling while in the fitness center or premises including sidewalks and parking areas. You acknowledge that you have carefully read this "waiver and release" form and fully understand that it is a release of liability. You agree to release and discharge Aligned Fitness and the APJCC fitness center and all it's affiliates, owners and employees of all claims or causes of action and you agree to voluntarily give up or waive any right that you may have to bring a legal action against Aligned Fitness or the APJCC for negligence, personal injury or property damage. Cancellation and Refund policy: Prepaid sessions can be used at any time while Aligned Fitness remains in business. There are no cash refunds. Individual training and postural alignment sessions can be cancelled with no incurred charge by giving a 24 hour notice by phone or email. If a 24 hour notice is not given, sessions will be charged at the full rate. Partner or group training sessions that have been scheduled are non-refundable regardless of prior notice. I acknowledge that Aligned Fitness and Lisa Decker and any subcontractor or employee working with Aligned Fitness does not have a medical license and cannot provide to me medical advice relating to my physical condition and ability to use the facilities. If I have any health or medical concerns now or in the future, I will discuss them with my doctor and receive a medical release before engaging with Aligned Fitness. Submitting this online form acts as a signature and agreement of the waiver above.
Aligned Fitness is non-medical and therefore, not a medical, chiropractic or physical therapy care provider and does not perform any services requiring a physician’s or other license. Aligned Fitness, Lisa Decker, and all other contractors and/or employees of Aligned Fitness do not diagnose or treat medical conditions. Because physical exercise can be subject to risk of injury, Aligned Fitness maintains that you obtain a physical examination from a licensed medical practitioner before participating in any exercise activity. You (client) agree that if you engage in any activity or use any amenity you do so entirely at your own responsibility and risk. Any recommendations for changes in diet, supplements, or weight reduction are entirely your responsibility and you should consult a physician prior to undergoing any dietary changes. You agree that you are voluntarily participating in all activities, exercises and use of the Aligned Fitness and premises and you assume all risks of injury or illness. Client understands that personal responsibility is a large component of postural therapy and personal training and therefore agrees to assume liability for any and all consequences of actions during therapy sessions and while doing exercises on own or with Aligned Fitness. I agree to inform Lisa Decker or any other employee of Aligned Fitness if any movement, exercise, or any direct physical contact feels dangerous or painful to the body. I agree to forgo the movement and not proceed further. I understand that therapeutic activities must be adjusted to physical limitations and therefore will inform Aligned Fitness of any physical limitations and will not undergo any exercise or movement I am not comfortable with. This waiver and release of liability includes without limitation all injuries which may occur regardless of negligence as a result of (a) your use of all amenities and equipment and your participation in any activity, program, exercise or instruction (b) the sudden and unforeseen malfunctioning of any equipment, fixture or device (c) any instruction, training, supervision or dietary recommendations and (d) your slipping and/or falling while in the fitness center or premises including sidewalks and parking areas. You acknowledge that you have carefully read this "waiver and release" form and fully understand that it is a release of liability. You agree to release and discharge Aligned Fitness and all it's affiliates, owners and employees of all claims or causes of action and you agree to voluntarily give up or waive any right that you may have to bring a legal action against Aligned Fitness for negligence, personal injury or property damage. Cancellation and Refund policy: Prepaid sessions can be used at any time while Aligned Fitness remains in business. There are no cash refunds. Individual training and postural alignment sessions can be cancelled with no incurred charge by giving a 24 hour notice by phone or email. If a 24 hour notice is not given, sessions will be charged at the full rate. Partner or group training sessions that have been scheduled are non-refundable regardless of prior notice. I acknowledge that Aligned Fitness and Lisa Decker and any subcontractor or employee working with Aligned Fitness does not have a medical license and cannot provide to me medical advice relating to my physical condition and ability to use the facilities. If I have any health or medical concerns now or in the future, I will discuss them with my doctor and receive a medical release before engaging with Aligned Fitness. Submitting this online form acts as a signature and agreement of the waiver above.
Please check the following box signifying you are in agreement with this waiver
By checking this box and submitting this form I agree to the above waiver
By checking this box and submitting this form I agree to the above waiver
Client Name
Date
MM slash DD slash YYYY

Client Intake Form
& Waiver

WAIVER & RELEASE FORM

Because physical exercise can be subject to risk of serious injury, Aligned Fitness maintains that you to obtain a physical examination from a licensed medical practitioner before participating in any exercise activity. You (client) agree that if you engage in any activity, whether on or off the Aligned Fitness premises, you do so entirely at your own responsibility and risk. You agree that you are voluntarily participating in all activities, exercises, and use of any premises and assume all risks of injury that can occur with physical exercise and stress on the body.

This waiver and release of liability includes without limitation all injuries which may occur regardless of negligence as a result of (a) your use of all amenities and equipment and your participation in any activity, program, exercise or instruction (b) the sudden and unforeseen malfunctioning of any equipment, fixture or device (c) any instruction, training, supervision or dietary recommendations and (d) your slipping and/or falling.

You acknowledge that you have carefully read this "waiver and release" form and fully understand that it is a release of liability. You agree to release and discharge Aligned Fitness and all its affiliates, owners and employees of all claims or causes of action and you agree to voluntarily give up or waive any right that you may have to bring a legal action against Aligned Fitness for negligence or personal injury.

Cancellation and Refund policy: Prepaid sessions can be used at anytime while Aligned Fitness remains in business. There are no cash refunds. Individual training and postural alignment sessions can be cancelled with no incurred charge with a 24-hour notice by phone or email. If a 24-hour notice is not given, sessions will be charged at the full rate. Partner or group training sessions are paid monthly and are non-refundable regardless of prior notice.
I
represent that I am in good physical condition and have no medical condition or impairment preventing me from physical exercise and assume all risk associated with physical exercise. If I have any health or medical concern now or in the future, I will discuss them with my doctor and receive a medical release before engaging with Lisa Decker and Aligned Fitness.
Printed Client Name
Client signature
Aligned Fitness Signature
Date
MM slash DD slash YYYY

Group Exercise Form
& Waiver

FAQs

Initial Appointment Instructions

Pricing(opens in new tab)

Relieve Chronic Pain & Increase Function

At Aligned Fitness we provide a holistic approach to treat the underlying dysfunctions and inefficient movement patterns that can cause chronic pain symptoms and limit you from enjoying life to its fullest.
Certified in Posture Therapy and Qigong, we use methods that promote structural, muscular, and nervous system rebalancing. We customize take home routines to restore posture, reduce muscle and joint wear & tear, and alleviate pain symptoms. These methods have a high success rate and require NO drugs, manipulation or surgery!

For years I've been struggling seeing therapist after chiropractor after spine specialist. Lisa took pictures of me and watched me walk, and detected a subtle twist in my entire back. As we have worked together she's listened and given me Egoscue© exercises I could have barely achieved before. My back has gotten so much relief! I am so grateful for practitioners like Lisa who listen, learn, and address the root dysfunctions!

E.B.

Posture therapy can reduce chronic pain symptoms such as:

Knee pain
Hip pain
Shoulder & Neck pain
Piriformis syndrome / Sciatica
Stenosis / Spondylolysthesis
Frozen shoulder
Plantar Fasciitis
Arthritis
TMJ & Migraines
If you suffer from any of these symptoms, there is an underlying imbalance that must be addressed. Find out how your unique alignment is connected to your pain before degeneration occurs. Our goal is to "empower" and "educate" each client with the tools to live a life without physical limitations or pain.

For years I've had constant back pain. I've been through several rounds of physical therapy. I've been to countless chiropractors. I even tried acupuncture. I received a referral to go see Lisa. I had no expectations going into the treatments, I just had an open mind. I was at a point where I was willing to try anything at any cost. After a couple weeks I couldn't believe it! I never thought I could live relatively pain-free. I just did the Egoscue© exercises as prescribed and I am almost completely pain-free now. I am so happy right now. I wish I had started going to Lisa 20 years ago.

B.P.

Posture therapy can reduce chronic pain symptoms such as:

Lower back pain
Knee pain
Hip pain
Shoulder & neck pain
Sciatica / Piriformis syndrome
Disc Herniations
Stenosis / Spondylolysthesis
Frozen shoulder
Plantar Fasciitis
Arthritis - Bursitis
TMJ & Migraines
If you suffer from any of these symptoms, there is an underlying imbalance that must be addressed. Find out how your unique alignment is connected to your pain before excessive degeneration occurs. Our goal is to "empower" and "educate" each client with the tools to live a life without physical limitations or pain.

For years I've had constant back pain. I've been through several rounds of physical therapy. I've been to countless chiropractors. I even tried acupuncture. I received a referral to go see Lisa. I had no expectations going into the treatments, I just had an open mind. I was at a point where I was willing to try anything at any cost. After a couple weeks I couldn't believe it! I never thought I could live relatively pain-free. I just did the Egoscue© exercises as prescribed and I am almost completely pain-free now. I am so happy right now. I wish I had started going to Lisa 20 years ago.

B.P.

Read Our Reviews on Google

(opens in new tab)

Sign Up For Our Newsletter

Sign Up Now
for Articles & Updates

Read Our Reviews on Yelp

(opens in new tab)

Subscribe to the Aligned Fitness You Tube Channel

(opens in new tab)

(opens in new tab)

Sign Up Now
for Articles & Updates

(opens in new tab)

(opens in new tab)

Aligned Fitness Posture Therapy & Qigong

Aligned Fitness Posture Therapy & Qigong

Relieve Chronic Pain & Increase Function

E.B.

Posture therapy can reduce chronic pain symptoms such as:

B.P.

Posture therapy can reduce chronic pain symptoms such as:

B.P.

Read Our Reviews on Google

Sign Up For Our Newsletter

Read Our Reviews on Yelp

Subscribe to the Aligned Fitness You Tube Channel

Aligned Fitness
Posture Therapy & Qigong

Aligned Fitness
Posture Therapy & Qigong