Online Movement Session - Intake Form

Thank you for your interest in Online Movement Coaching with Judith Aston.

In order to confirm your appointment, please fill out this form in its entirety and submit by 4:30 pm PST 3 days before your scheduled appointment.

If you have any additional questions, please feel free to contact us at:


Name *
Check any of the following that apply to your personal medical history:
Posture, movement, efficiency, stress relief, athletic performance, etc.
System Requirements *
Online movement coaching requires certain system requirements to use Skype. Due to a high volume of scheduling inquiries, the appointment time you schedule begins within 5 minutes of the beginning time. If there are technical difficulties during your session, we do not refund or allow for additional time. It is your responsibility to ensure that technical issues are resolved before your scheduled appointment. I understand these requirements and know that it is my responsibility to handle all technical difficulties prior to my appointment. I also understand that there will be no refunds, allotment of extra time or credits of any kind if my technology does not work during my online movement lesson.
Disclaimer *
I understand that this Aston movement session is not a teacher training class: it is for my personal use only. I understand that Aston Kinetics cannot be responsible for instructing other in this content. I understand that the Aston Kinetics program is not a substitute for medical treatment. I take responsibility for my body and my participation in this session. I release Aston Paradigm Corporation and its agents from all rights and claims with respect to this session.
Please type your full name