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New Client Form
Please fill out this form before your first session to help us understand your needs and ensure a safe, enjoyable experience.
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Ukraine
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Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
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Other
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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4
Emergency Contact Details
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First Name
Last Name
Phone number
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5
Current Exercise Regime
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No
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No
Do you currently exercise?
If yes, how often? (eg. 2 times a week)
What type of exercise?
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6
Have you ever performed Pilates before?
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NO
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7
What are your Pilates goals?
Feel free to tick multiple
Improve core stability
Enhance flexability
Improve strength
Improve posture
Tone the body
Lose weight
Injury management
Other
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8
Tick any that apply to you
I have a heart condition
I feel faint or dizzy during physical activity/exercise
I experience pain in my chest at rest or during physical activity/exercise
I have had surgery in the last 6 months
I have suffered a stroke
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9
Do you have or have you ever had and of the following?
Multiple answers can be selected
Osteoporosis
Rheumatic conditions
Reflux
Asthma
Hernia
Cancer
Arthritus
Gout
Epilepsy
Vertigo
High blood pressure
Infectious diseases
Other
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10
If you selected any of the previous medical conditions, please give more details
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Do you have any other medical conditions that may prevent you from participating in physical activity/exercise?
If yes, please give details below
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12
Pregnancy
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Are you currently pregnant?
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No
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No
Have you given birth in the last 6 weeks?
If you have previously given birth, please give details (natural, caeseran, any complications, abdominal seperation, etc.)
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13
I have had clearance from a medical professional to be able to participate in Reformer Pilates
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NO
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14
Physical Touch and Corrections
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Our instructors will monitor and correct your Pilates technique in a variety of ways through verbal cues and physical touch to move the body into the correct position or check that the correct muscles are working. Do you consent to having the instructor touch you to perform these corrections? *Note majority of the classes will be virtual meaning there will not be an instructor there during those classes.
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