Reform Your Health | Reform ABQ

1 About You

Full Name *

Date of Birth *

Sex *

2 Height & Weight

Height (ft) *

Height (in) *

Weight (lbs) *

3 Are you a new or returning patient for a movement plan?

New patient First time creating a plan with us Returning patient I have done a plan before and have feedback

4 Current Medical Conditions

Select all that apply. This helps us keep recommendations safe.

5 Spine, Joint & Musculoskeletal History

Select all that apply. These strongly influence exercise selection and modifications.

6 Surgeries, Joint Replacements & Procedures

List any relevant surgeries, joint replacements, spinal procedures, or significant injuries (with approximate year if known)

Include joint replacements, spinal fusions/discectomies, arthroscopies, fractures with hardware, etc.

7 Current Medications

List medications, supplements, and doses if known

Include hormone therapy, GLP-1s, blood pressure meds, insulin, etc. Even if you upload a previous plan, list current medications — they may have changed and affect safety notes.

8 Equipment, Time & Experience

9 How many days per week can you commit to working out?

1 day 2 3 4 5 6 days

3 days per week

10 Primary Goal

Options update based on the sex you selected above. Select one, then add any extra notes for customization.

Additional notes or customization requests (optional)

These notes will appear on your generated plan for reference.

YOUR HEALTH

1 About You

2 Height & Weight

3 Are you a new or returning patient for a movement plan?

4 Current Medical Conditions

5 Spine, Joint & Musculoskeletal History

6 Surgeries, Joint Replacements & Procedures

7 Current Medications

8 Equipment, Time & Experience

9 How many days per week can you commit to working out?

10 Primary Goal

Your Personalized 12-Week Starter Plan

Patient Snapshot

Nutrition Targets (Starting Point)

12-Week Training Overview

Help us improve (optional)