Client Form Pilates

  • Client Health and Data Form - Pilates

  • Personal information

  • Date of Birth
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  • Emergency contact name         Number      

  • Data

  • Your personal data will only be used by Teresa Sedge Pilates and Sports Therapy (TSPST) and those teachers covering your class. Please confirm that you give permission for TSPST to contact you via:
  • Please also confirm that you give permission for TSPST to:

  • For more information on the Privacy Policy, go to www.pilatesandsportsthearapy.co.uk

  • Medical/Health Questions

    The following information will be used to help plan safe and effective Pilates sessions. Please answer the questions to the best of your knowledge.
  • Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? (If yes, please explain in Notes)*
  • Do you ever feel pain in your chest when you do physical activity? (If yes, please explain in Notes)*
  • Do you have difficulty lying on your front, back or side? (If yes, please explain in Notes)*
  • Do you ever feel faint or have spells of dizziness? (If yes, please explain in Notes)*
  • Do you have a joint problem (also back problem) that could be made worse by exercise? (If yes, please explain in Notes)*
  • Have you ever been told that you have high blood pressure? (If yes, please explain in Notes)*
  • Are you currently taking any medication of which the teacher should be made aware of? (If yes, please explain in Notes including reason)*
  • Are you pregnant or have you had a baby in the last 6 months? (If yes, please explain in Notes including reason)*
  • Are there any other reasons why you should not participate in physical activity? (If yes, please explain in Notes including reason)*

  • IF YOU HAVE ANSWERED YES TO ONE OR MORE QUESTIONS:

    You should talk to your doctor by phone or in person before you start becoming more physically active and before you start Pilates. Tell your doctor about the questionnaire and which questions you answered YES to. If you have already got medical clearance for Pilates or moderate exercise in general, please fill in the declaration form on the next page.

     

    IF YOU HAVE ANSWERED NO TO ALL QUESTIONS:

    You can reasonably be sure that you can start to become more physically active and take part in a suitable exercise programme. Do begin slowly and build up gradually.

     

    PLEASE NOTE: If your health changes subsequently so that you answer YES to any of the above questions, please let TSPST know as soon as possible. If you are temporarily unwell (eg cold/flu), delay becoming more active until you are better.

  • DECLARATIONS

  • TERMS AND CONDITIONS

    Cancellation within 24 hours (Friday for Monday) of a private lesson will be charged in full. For the ongoing health of teachers and clients, TSPST and freelance teachers will refuse to teach a client who is evidently not well. Refunds cannot be given for missed group classes. 

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