Welcome

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

How old are you?* This field is required.

4

Phone Number* This field is required.

Please enter a valid phone number.

5

How did you hear about me?* This field is required.

6

If this was a referral, please tell me who referred you (I want to thank them!).

7

Have you done Pilates before?* This field is required.

Never

I have tried a class before

I used to take classes but it has been awhile

I regularly practice Pilates

8

What other physical activities are you currently doing?* This field is required.

9

How would you describe yourself?* This field is required.

Competitive athlete

Recreational athlete

General fitness

Returning to exercise after a break

10

What's the main reason you're looking for private Pilates right now?* This field is required.

11

What does success look like for you after 3 months of consistent training?* This field is required.

12

What's gotten in the way of your fitness goals before?* This field is required.

13

How soon are you looking to start?* This field is required.

As soon as possible

Within the next month

Just exploring for now

14

Do you have any current injuries or physical pain?* This field is required.Depending on your situation, we may need medical clearance before starting. I'll review your answers and be in touch personally.

Yes

No

15

If you answered yes, please describe your injury or pain briefly.* This field is required.

16

Have you had surgery or a significant medical procedure in the past 12 months?* This field is required.Depending on your situation, we may need medical clearance before starting. I'll review your answers and be in touch personally.

Yes

No

17

If you answered yes to the previous question, please describe briefly.* This field is required.

18

Do you have a chronic medical condition? (e.g. heart condition, spinal issue, autoimmune disorder) If yes, please describe.* This field is required.Depending on your situation, we may need medical clearance before starting. I'll review your answers and be in touch personally.

19

Are you currently pregnant or postpartum (within the past 12 months)?* This field is required.

Yes

No

20

Are you currently under the care of a doctor, PT or chiropractor?* This field is required.Depending on your situation, we may need medical clearance before starting. I'll review your answers and be in touch personally.

Yes

No

21

What are you being treated for?* This field is required.

22

How many sessions per week are you hoping to train?* This field is required.

1

2

3

Not sure yet

23

Sessions are sold in packages, not as drop-ins. Does that work for you?

Yes, that works

I'd like to discuss on the call

No

24

On a scale of 1–5, how ready are you to commit to a regular schedule?* This field is required.1 is "just curious" and 5 is "ready to go!"

1

2

3

4

5

25

Anything else you'd like me to know before our call?* This field is required.

26

Please confirm you have read and agree to the following:* This field is required.All boxes must be ticked.

I agree to be contacted by Casey.

This studio does not provide medical treatment or rehabilitation.

All health information provided is accurate to the best of my knowledge.