New Client Registration Form
Please complete this online registration form.
All information contained within this form is considered confidential. It will not be shared with any third parties. If you would prefer a hard copy, please email info@mybody.com.hk.
Start
 
What is your title? *


 
What is your surname? *

 
What is your first name? *

 
Do you have a middle name?

If YES, please write your middle name/s here.
If NO, please press the DOWN arrow to continue.
 
What is your date of birth? *

 
Please choose your gender. *


 
What is your HKID number?

 
Please enter your mobile phone number.

 
Do you have a home telephone number?

If NO please press the DOWN arrow to continue.
If YES please enter your home telephone number below.
 
Do you have an office telephone number?

If NO, please use the DOWN arrow to continue.
If YES, please enter your office telephone number below.
 
Which is your preferred method of communication? *


 
Would you like to receive regular updates from My Body, fitness and health tips and special promotions?

Sign up to our e-newsletter (don't worry we won't bombard your inbox!)
     
 
What is your home address? *

 
If we are coming to you, please provide details of the closest parking to your building.

 
What is your correspondence address?

If it is the same as your HOME address, please leave this section BLANK.
If it is different, please enter below.
 
Who should we invoice? *


 
Please enter the name, postal address and email address of the person we will invoice.

If we are invoicing you, please leave this section BLANK, press the DOWN arrow to continue.
 
{{answer_25404157}}, what is your occupation?

 
In case of emergency...

 
Please enter the name of your emergency contact? *

 
What is their relationship to you? *


 
Please enter your emergency contact's mobile number? *

 
Does your emergency contact also have a home or office telephone number?

If NO, please press the DOWN arrow to continue.
If YES, please enter below.
 
Will you be claiming your physiotherapy expenses on insurance?

     
 
Who is your insurance provider?

If you are NOT claiming on your insurance, please leave this section BLANK. Press the DOWN arrow to continue.
 
How did you find out about My Body?


 
Are you:
Pregnant?
Recently postpartum?

Please provide further details below (due date/delivery date etc).
 
Please confirm the following details.

Name: {{answer_25404106}}{{answer_25404157}}{{answer_25404209}}{{answer_25404150}}
Date of birth: {{answer_25404262}}
HKID: {{answer_25480417}}
Home address: {{answer_25404898}}
Mobile number: {{answer_25404493}} Home telephone: {{answer_25404838}}
Office telephone: 
{{answer_25404870}}
Email address: {{answer_25404889}}

Send invoice to: {{answer_25442530}}

Emergency contact: {{answer_25443005}}{{answer_25443602}}



 

Thank you for taking the time to fill in this form.

Please check out our website www.mybody.com.hk for interesting reads and information.
If you have any questions, please don't hesitate to contact us 9186 6551 or info@mybody.com.hk.
Thanks for completing this typeform
Now create your own — it's free, easy & beautiful
Create a <strong>typeform</strong>
Powered by Typeform