About Regina
Focal Points
Movement
Meditation
Mindset
Classes
Live Remote
On Demand
What Clients Say
Connect
Buy
Contact Information
*
Indicates required field
Name
*
Email
*
Cell Phone
*
Home Phone
*
Emergency Contact
*
Emergency Contact Phone
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Physician
*
Physician Phone
*
Profile
Birthday
*
Height
*
Weight
*
If you have any kind of pre-existing conditions that may affect your ability to participate in any exercise program, please let me know and consult a health care practitioner before participation.
Possible Ailments:
*
Back Pain
Low Flexibility
Surgeries
Stress
Asthma
Migraines
Chronic Illness (please specify below)
Neck Strain
Knee Injury
Shoulder Injury
Sciatica
Description/Other
*
If you currently participate in other physical training activities, please let me know which ones below:
*
What are some of your goals in starting an exercise program?
*
I appreciate your business and thank you for your confidence in my services. If you have any questions, suggestions, comments and such, please let me know so that I can offer you the best fitness and wellness program possible!
-Regina Santos
Submit
About Regina
Focal Points
Movement
Meditation
Mindset
Classes
Live Remote
On Demand
What Clients Say
Connect
Buy
