Order an Exercise Prescription

Complete and submit this form to send your details and photos to FutureGym:
Once submitted, you'll need to visit the FutureGym Shop to complete your order and pay for your prescription.
 

Name (required)

Country (required)
---AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia, Plurinational State ofBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of theCook IslandsCosta RicaCôte D'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle Of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan Da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

Email Address (required)

How long have you been practicing the FutureGym program? (required)
weeksmonthsyearshaven't started yet

Occupation (required)

List any injuries, surgery, areas of pain and anything else we need to know that may affect your prescription (state approx date of event and treatment history if this is applicable) (optional)

List any currently known movement limitations and/or restrictions (optional)

Instructions for taking photos

Make sure you capture your full body. Ensure that all photos include the top of your head and your feet. For best results we recommend you wear a swimming costume or under garments. We ensure you full confidentiality and will not use your photos for any other reason than this evaluation. If you don’t want to be recognised wear a mask or sunglasses. If a mask is worn please ensure that the back of your head and neck are not covered.

Standing position. When taking each of your photos please stand with your feet approximately 120 to 150mm apart, have your toes facing directly forward and your heels facing directly backwards. (Do not stand with your feet in a ‘V’).

Lighting. Please make sure that the lighting is appropriate so your pictures are clear and your body is easy to see.

Instructions for uploading photos

Loading photos onto your computer. You will need to upload the photos you have taken from your computer. To get them into your computer you will need to scan them in using a scanner or you can download them from a digital camera.

Adjusting photo size and selecting the right format for uploading. Your photos must each be under 500kb in size and must be saved in .jpg format.

Uploading photos. Our ‘Attach Photo’ button opens a computer browser which will allow you to select each of your three photo files for sending.

Photo Examples

Front

Side

Back

Upload Your Three Photos Here

Please select photos under 500kb from your computer or reduce each photo size to 500kb or smaller.