Home Assessment form

If you would like to get in touch with me to discuss options before filling in this form, please contact me.


Occupancy: *
Do you have pets?
Type of property: *
Please note down what goals and expectations you have
If you have anything you'd like us to answer pop it in here
eg swapping chairs for floor cushions, changing the lighting
Noise level: *
Can you hear your neighbours or the road when you're inside
Light level: *
Do the street lights mean there is no darkness at night
Do you know your neighbours?
Do you have friends nearby?
Do you feel safe in your neighbourhood?
Do you feel safe at home?
Is there much green space near where you live?
Are you in walking distance from a park, beach, nature reserve? Do you have a garden?
Are there shops nearby you walk to?
How often do you cook?
Whenever I can I choose to walk to places:
How much screen time do you have daily?
Roughly estimate how much, including at work, when watching TV, on social media
I often take cold showers:
How active are you?
Do you cycle to work? Walk to the shops?
I often turn the heating or air conditioning on:
Do you have any allergies?
Have you had root canal treatment?
How did you hear of Movementum?
Are you comfortable for any photos / videos of your business to be shared online or on social media?
I will never post anything without first asking your permission.
The Small Print
Cancellation Policy *
I respectfully ask that you provide me with a 24 hour notice of any schedule changes or cancellation requests. When you cancel or miss your appointment without providing a 24 hour notice I am unable to fill that appointment time. For this reason, you will be charged 50% of the service fee for the first missed session and 100% of the service fee for each appointment after that. I understand that emergencies can arise and illnesses do occur at inopportune times. Late cancellation due to emergency, illness, or inclement weather will generally not result in any missed appointment charges, but this is determined on a case-by-case basis.
Privacy Policy *
We do not share any of your information with any third parties or profit from your personal information and data. Our Privacy Policy can be found at the bottom of each page.
Please write your name or initials in the box below. By signing this form electronically you are agreeing to the terms and conditions herein.
Date Today *
Date Today