Yoga Client Form
Thank you for joining! Please take a few minutes to tell us about yourself so we can tailor your Pilates experience to your needs and goals.
Full Name
*
First Name
Last Name
Phone Number
*
-
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
Town
State
Post Code
Emergency Contact Name
First Name
Last Name
Emergency Contact Number
-
Area Code
Phone Number
Please check the conditions that apply to you
*
Asthma
Cancer
Cardiac disease
Diabetes
Hypertension
Psychiatric disorder
Epilepsy
Broken Bones
Spinal Concerns
Musculoskeletal Discomfort
NONE
Are you pregnant?
Yes
No
Are you currently taking any medication?
*
Yes
No
Do you have any other: injuries/conditions/illnesses I should be aware of?
Do you have your doctor/GP/Specialist/Physiotherapist blessing to join Yoga classes?
YES
NO
Have you done Yoga before
Yes
No
Signature
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
SUBMIT
Should be Empty: