Registration Forms 

 

Before we set sail, tell me about your journey... 

 

Physical Readiness Questionnaire

This is required prior to any of the ShipShape Services.  

 

Exercise History Intake Form

This will give me a brief background about your physical activity levels and what you're looking for from our time together. 

 

Resource Documents

Below are links to additional resource documents. Feel free to print these out and use as part of your ShipShape journey.

How to Fall Safely

Description and pictures of techniques to reduce the impact of a fall.

Balance, Breath & Movement Exercises

Stretching, balance, and movement exercises to help with balance and mobility.

Aging Well Exercises - Floor/Bed

Stretching exercises done on the floor or bed to help with core strength, posture and mobility.

Rate of Perceived Exertion

Modified Borg Scale to identify level of exertion during cardiovascular exercise.

SMART Goals Worksheet

Use this worksheet to document and track your goals for success!

Perceived Stress Scale (PSS)

The Perceived Stress Scale (PSS) is a classic stress assessment instrument. The tool, while originally developed in 1983, remains a popular choice for helping us understand how different situations affect our feelings and our perceived stress.

Stages of Change/Change Plan Worksheet

As a first step, identify where you are in your readiness to make a behavior change. Behavior change is a process that unfolds over time involving progress through a series of stages.

Computer & Desk Stretches

Print and post these stretches by your desk and do them throughout the day to alleviate and reduce neck and shoulder stiffness.

Check Your Risk for Falling

This checklist was developed by the Greater Los Angeles VA Geriatric Research Education Center and affiliates, and is a validated fall risk self-assessment tool.