Pre-Assessment Form

Client Application
Emergency Contact
How much coverage do you have for:
Past Medical History

Do you have currently, or have you ever had in the past, any of the following:

Medical Information
Remember to include with your application the Physicians Clearance Form - required for acceptance into the Aim2Walk program

Please describe your current physical abilities:

By completing the below, you are acknowledging that you have completed this application to the best of your knowledge. You understand that medical clearance is required before beginning any protocol program, and Aim2Walk has the right to deny your participation in the program if requests are not fulfilled and/or this application is not completed fully.

Thank you for completing and submitting this application. Your next step is to book a tour and free consultation with our clinic Director. Call us at 416-679-9255 to schedule at your convenience.

Please note, your application will remain on file for 1 year following its submission to Aim2Walk

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