Reformer Pilates 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
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
What fitness and health goals do you wish to acheive through Pilates
*
Increase flexiblity
Increase strength
Increase lung capacity
Toning
Relaxation
Alignment & posutre correction
Pain relief
Balance
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 Pilates classes?
YES
NO
Have you done Reformer Pilates before
Yes
No
Have you done Mat Pilates before
Yes
No
What is your current Pilates level?
Beginner
Intermediate
Advanced
Never done Pilates before
What are your main goals for doing Pilates? Example: I want to focus on core and upper body strength.
Signature
Date
-
Month
-
Day
Year
Date
SUBMIT
Should be Empty: