Name *

First Name

Last Name

Phone

(###)

###

####

Birthdate *

MM

DD

YYYY

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

Country

(###)

###

####

How is your sleep these days? *

Choose one or more options that best describe your current state.

Amazing. I wake up most mornings feeling completely refreshed.

Mostly good with bouts of insufficient sleep.

Not great, I regularly get less than 6 hours of sleep and/or my sleep is interrupted.

Terrible, I am exhausted and at capacity with my lack of sleep.

How is your stress level these days? *

Choose one or more options that best describe your current state.

Minimal to no stress.

Regular stress that feels like a normal part of life. I can handle it.

A lot of stress right now that is impacting my life negatively.

So much stress that it is disrupting my life and I am at capacity.

Cancellation Policy *

Cancellations made within 24 hours of your appointment will incur a full session charge. At this time, cancellations due to illness or emergencies will be subject to the same cancellation policy at my discretion. Even if I can accommodate rescheduling your session within the same day or week, please understand that this is still considered a cancellation, and you will be charged for both the original and the new session. If you have a recurring weekly timeslot and you cancel or reschedule multiple times within a 3-month period, (regardless of whether or not it’s a last-minute change), I may not be able to continue reserving that designated time slot for our session. We will then discuss other scheduling options. Sessions will automatically be canceled if you are more than 20 minutes late for a 50-minute session, 15 minutes late for a 45-min session, or 10 minutes late for a 30-min session. Thank you for understanding that this policy allows me to run my business in a way that is sustainable.

I agree to this policy.

Liability Waiver *

I hereby release Alia Bisat and Alia Bisat Movement Coaching from any responsibility or liability due to my participation in movement coaching sessions. I am fully aware that I am participating in these sessions at my own risk and will not hold those named above responsible in the event of my incurring an injury or exacerbating any previously existing conditions. If I have any medical conditions I have consulted with my physician to make sure that movement coaching is appropriate for me to participate in.

I agree