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MOBILITY RITUAL

MOBILITY & DYNAMIC FITNESS ASSESSMENT™

MOBILITY & DYNAMIC FITNESS ASSESSMENT™

7-minute diagnostic to uncover the real reasons your body feels stiff, tight, or limited — and identify the fastest path to pain-free movement.

SECTION 1 — GENERAL INFORMATION

Your Full Name: *

Your Best Email *

Phone Number (Optional)

Your Age Range; *

Under 25

25–34

35–44

45–54

55–64

65+

How often do you currently workout per week? *

0–1 times

2–3 times

4–5 times

6+ times

What are your fitness goals? (Select all that apply) *

Improve strength

Lose weight

Improve flexibility

Improve mobility

Reduce joint pain or stiffness

Prevent injuries

Improve posture or movement quality

Return to sport (golf, tennis, skiing etc.)

Other fitness goal:

SECTION 2 — JOINT PAIN & DISCOMFORT

Rate your current pain in the following areas
(0 = No pain / 10 = Severe pain)

Neck *

0

1

2

3

4

5

6

7

8

9

10

Shoulder *

0

1

2

3

4

5

6

7

8

9

10

Upper Back Area *

0

1

2

3

4

5

6

7

8

9

10

Lower Back Area *

0

1

2

3

4

5

6

7

8

9

10

Hip Area *

0

1

2

3

4

5

6

7

8

9

10

Your Knees *

0

1

2

3

4

5

6

7

8

9

10

Your Ankles *

0

1

2

3

4

5

6

7

8

9

10

Elbows/Wrists *

0

1

2

3

4

5

6

7

8

9

10

SECTION 3 — MOBILITY & FLEXIBILITY

Describe your overall mobility? *

Excellent — move easily, no limitations

Good — minor tightness

Fair — restricted in multiple areas

Poor — mobility is a daily struggle

Which areas feel tightest or most limited? *

Neck

Shoulders

Thoracic Spine

Hips

Hamstrings

Ankles

Lower Back

Another Area?

How confident do you feel performing daily movements? *

Very confident

Somewhat confident

Occasionally limited or cautious

Frequently restricted or in pain

How often do you include mobility/stretching in your routine? *

Daily

3–4x per week

1–2x per week

Rarely or never

How would you describe your posture? *

Excellent

Good

Needs improvement

Poor

Not sure

SECTION 4 — MOVEMENT IMPACT & FUNCTION

How often does stiffness or pain limit your workouts or day-to-day activities? *

Never

Occasionally

Frequently

Almost always

Have you had an injury that still affects your movement? *

Yes

No

If yes, describe: *

What would improved mobility allow you to do comfortably?

Motivation level to improve mobility (0–10): *

0

1

2

3

4

5

6

7

8

9

10

How stable do your joints feel in general? *

Very stable

Mostly stable

Sometimes unstable

Unstable / give-way feeling

SECTION 5 — BALANCE, CONTROL & ATHLETIC READINESS

How would you rate your balance? *

Excellent

Good

Fair

Poor

Do you feel confident getting up/down from the floor? *

Very confident

Somewhat

Only with support

Avoid it completely

Do you struggle with: (Select all that apply) *

Stiff mornings

Low energy

Wobbly knees

Weak grip strength

Tight hips

Tight lower back

Shortness of breath during simple movement

None

SECTION 6 — JOINT SURGERY OR REPLACEMENT HISTORY

Have you had any joint replacements or surgeries? *

Yes

No

If yes, which?

Shoulder

Elbow

Hip

Knee

Ankle

Spine

Other Surgery or Replacement:

When was your most recent surgery?

Within last 6 months

6–12 months

1–3 years

More than 3 years

Are you currently following post-surgery guidelines or physio?

Yes

No

Do you feel fully recovered?

Fully recovered

Partially recovered

Still limited or in pain

Anything else I should know?

SECTION 7 — FITNESS & WORKOUT ABILITY

What type of training are you currently doing? (Select all that apply)

Strength training (weights, TRX, kettlebells)

Cardio (walking, cycling, running, rowing)

Classes (HIIT, circuits, etc.)

Mobility / stretching

Sports (golf, tennis, skiing, football, martial arts)

None / currently inactive

Other types of activity:

How would you rate your current strength level?

Strong — can lift, push, pull with confidence

Moderate — can do some strength work but cautious

Very low — almost no strength training currently

Can you confidently perform any of the following? (Select all that apply)

Squat to a chair and stand without using hands

Push-ups (wall)

Push-ups (knee)

Push-ups (full)

Plank (20–30 seconds)

Plank (30–60 seconds)

Deadlift or hinge without pain

Step-up onto a step or low box

None of the above feel comfortable

How would you describe your cardiovascular fitness?

Excellent — rarely out of breath

Good — mild fatigue but manageable

Fair — get out of breath easily

Poor — avoid cardio due to discomfort or fatigue

How confident are you using equipment like kettlebells, dumbbells, or a suspension trainer?

Very confident

Somewhat confident

Not very confident

Not very confident

Any other equipment you like to use?

How consistent are you with workouts?

Very consistent (4–5+ sessions per week)

Consistent (2–3 sessions per week)

Inconsistent (1 session per week)

Rarely / never

What currently LIMITS your ability to work out? (Select all that apply)

Joint pain

Lack of mobility

Low energy

Lack of time

Fear of injury

Don’t know what to do

Nothing — ready to train

Any Other limitations?

What type of workouts do you prefer? *

Short sessions (10–20 mins)

Medium (20–40 mins)

Long sessions (45+ mins)

No preference

I struggle to stay consistent with any session length

I don't enjoy exercising

Would you like a fitness program that includes… *

Strength + mobility

Just strength

Just mobility

Loaded Movement Training

Cardio + mobility

Cardio + strength

Sport-specific training

Pain-relief & gentle progressions

Not sure

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