Student Questionnaire

Seed Pilates + Movement Training is meant to be a safe and welcoming space for all bodies to exlopre a movement practice free of judgement.

To assist me in estabilshing successful programing for your sessions in a way that will honor your needs and interests, please answer the following questions to the best of your ability.

Name*

First NameLast Name

Pronouns

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Date of Birth

Date

While Pilates is a movement based practice, no system of our body functions in isolation. With that in mind, please list and explain any previous or current injuries, accidents, illness and/or conditions that may be relevant to your Pilates practice, including any chronic/persistent pain and/or injuries:

If you have structural conditions and/or movement difficulties that may impact your Pilates or movement practice, please explain here (ex. Osteoporosis, Scoliosis, leg length discrepancy, etc):

If currently undergoing medical treatment, please explain here:

List of allergies, if any:

What is your familiarity with Pilates: (not familiar) 0 - 5 (very familiar)

What is your interest in Pilates and what goals do you have for your Pilates or movement practice?*

Occasionally, gentle hands on feedback and correction can be a useful tool. Before any use of touch, the instructor will always ask for consent and will make it clear what part of the body they intend to touch and why. Area's of touch may include shoulders, back, hips, knees and feet; area's that will never be touched include the chest and genital regions along with any other areas you do not wish to receive touch. Allowing the instructor to touch your body is not a requirement and you are able to reject the request at anytime and for any reason. Please select which option below most generally reflects your wishes (more details may be added in the next section below).*

I might be ok with occasional and consensual touch for feedback and correction; please feel free to ask for permission when needed.I do not want to be touched in any context and would prefer not to be asked if I'm ok with it.

Additionally, please let me of any areas of the body you would not like to be touched or if you have any triggering words or movements I should avoid using.

Do you have any access needs? If yes, please let me know here - Note that I try to the best of my ability to create access for all but I will let you know if I am not able to accommodate something you need.

Any additional information you'd like to share with me?