Thea Gudgeon - Health Screen & Informed Consent Logo
  • Health History Screening & Informed Consent:

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  • This form covers all of my modalities. I only require you to answer the questions that are relevant to your class/appointment with me:


    Have you had any medical treatment?
    This could include arthritis, diabetes, heart disease, blood pressure, asthma, epilepsy, autoimmune conditions, cancer or something else. Please include any surgeries:

  • Have you had any of the following?

    Surgeries, Joint problems, spinal issues, joint replacement, osteoporosis/osteopenia, peripheral neuropathy (numbness/tingling), or something else:

  • Have you had any pregnancy/previous deliveries?

  • Waiver of Liability and Informed Consent Release for Pilates, Movement, Transformative Coaching and Massage/Fascial Therapy sessions: 

    Pilates & Movement:

    I am participating in a programme of instruction in Pilates or movement. I have been advised and understand that participation in Pilates, like any physical conditioning or exercise programme, although low risk, could present some unavoidable risk of injury. I also understand that the use of equipment carries with it a risk of injury. I also recognise that many changes may occur as a result of these sessions, including possible short-term aggravation of some symptoms, feelings of tiredness, increased energy and mood changes.

    I also understand that sometimes medical evaluation is appropriate before commencing any programme of physical conditioning or exercise.

    I accept it is my responsibility to keep my teacher constantly informed of any changes in my health, and any physical condition or disability which would prevent or limit my participation in any exercise programme. I acknowledge that, although the programme may have substantial physical benefits, and my Pilates teacher may offer their opinion, they are not diagnosing medical diseases or musculoskeletal issues.

    I expressly assume all risks of my participation in this Pilates or movement programme and waive any claim, which I might otherwise bring against my teacher, as a result of injuries from or relating to my participation in the session. 

    Massage and Fascial Therapy:

    I recognise that many changes may occur as a result of these sessions, including possible short-term soreness or discomfort, feelings of tiredness, increased or decreased energy and mood changes.


    I accept it is my responsibility to keep my practitioner constantly informed of any changes in my health, and any physical condition or disability which would affect the treatment. 

    I acknowledge that, although the practitioner may offer their opinion based on their knowledge and experience, they are not a Medical professional so cannot provide definitive diagnosis.

    I expressly assume all risks and understand my practitioner cannot guarantee the outcome of any session. I waive any claim, which I might otherwise bring against my practitioner, as a result my participation in the session

     

    All clients:

    I understand that if I have to cancel a scheduled 1:1 appointment or class I must notify my teacher a minimum of 24 hours in advance, or I will be held responsible jfor payment in full.

    If I purchase a block of 1:1 sessions I understand they have an expiry date.

    I understand that block bookings of in person classes are not fully or part refundable if I cannot attend all of the sessions.

    I understand if booking an online class that I will not be refunded if canceling with less that 24 hours notice.

    I understand that in confirming my appointment I agree to the 24 hour cancellation policy detailed above.

     

    Privacy & GDPR Policy:

    I care about your privacy and I am committed to protecting your personal data, in line with the UK General Data Protection Regulation (UK GDPR).

    What I Collect

    When you book an appointment, class or get in touch with me, I may collect:

    Your name and contact details (email, phone number)
    Any health information relevant to your work with me
    Booking and payment details

    Why I Collect It

    I use your information to:

    Manage your bookings and communicate with you
    Personalise your sessions and ensure your safety
    Meet my legal and administrative obligations

    How I Keep It Safe

    All data is stored securely and accessed only when needed to provide my services. Ie will never sell or share your information without your permission, unless legally required to do so.

    Your Rights

    You have the right to:

    Access and correct your personal data
    Ask me to delete your data (where legally possible)
    Withdraw your consent at any time

     

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