CLIENT  DETAILS: Name: __________________________________________ D.O.B______________________ Address:____________________________________________________________________ Contact  Number:____________________________________________________________ 1.      Goals for participating in this program are:  (  please tick or cross ) 0   Improve balance                 0   Increase fitness                        0   Increase flexibility 0   Increase social contact       0   Prevent health problems            0   Increase strength   2.      Does the client have any of the following health conditions? __  … Continue reading MEDICAL REFERRAL