• Part 1 - Personal Details

  • What type of sessions are you planning on attending?*
  • Date of birth*
     - -
    2 digit day, 2 digit month, 4 digit year

  • Emergency Contact Details

  • Part 2 - Your background and your health

  • 1. Have you practiced Pilates before??*
  • 1b. How many classes have you attended?
  • 2. Has your doctor ever said that you have any sort of heart trouble or defect?*
  • 2a. Do you have medical clearance to exercise?*
  • 3. Do you feel any pain in your chest when you undertake physical activity?*
  • 3a. Do you have medical clearance to exercise?*
  • 4. Are you, or could you be, pregnant now?*

  • Please be aware, group classes are not suitable during pregnancy. Classes are suitable for post natal clients from 6 weeks post natal (normal delivery) and 12 weeks post natal (caesearean) with a pregnancy qualified teacher. Please do not complete this form - email sam@mylocalpilates.com to discuss your options.

  • 5. Have you been pregnant in the last six months?*

  • Please be aware, group classes are not suitable during pregnancy. Classes are suitable for post natal clients from 6 weeks post natal (normal delivery) and 12 weeks post natal (caesearean) with a pregnancy qualified teacher. Please do not complete this form - email sam@mylocalpilates.com to discuss your options.

  • 6. If you have had a baby, how was it delivered?
  • 7. Do you often get headaches?*
  • 8. Do you ever...*
  • 9. Is your blood pressure...*
  • 10. Have you had major surgery in the last 10 years?*
  • 11. Have you had minor surgery in the last 2 years?*
  • 12. Do you suffer from...*
  • 13. Have you been diagnosed with...*
  • 14. Have you ever been told that you have a joint or soft tissue problem that may be made worse by exercising?*
  • 15. Do you suffer with...*
  • 16. Do you have pain or restricted movement in any of these joints...*
  • 17. Have you been diagnosed as hypermobile? (excessive joint mobility)*
  • 18. Are you taking any drugs or medication which may affect your ability to exercise?*
  • 19. Do you suffer from digestive complaints (ulcers, reflux, colitis etc.)?*
  • 20. Have you noticed any bowel or bladder dysfunction?*
  • 21. Have you noticed any recent unexplained weight loss?*
  • 22. Have you been diagnosed with any form of cancer?*
  • 23. Do you suffer from any neurological conditions or diseases?*
  • 24. Do you suffer from any inflammatory conditions or diseases, (such as rheumatoid arthritis, polymyalgia rheumatica etc.)?*
  • 25. Have you suffered any broken or fractured bones (including stress fractures)?*

  • Part 3 - Important Information & Permissions

  • Have you been recommended to take up Pilates by a specialist practitioner?
  • Do you hereby give us permission to contact them?*

  • Please advise us before commencing any session if, for any reason, your health or your ability to exercise changes.


    It is inadvisable to do Pilates between weeks 8 to 14 of pregnancy, unless by special arrangement with your teacher. It is also wise to wait six weeks after the birth before resuming exercise.

    Pilates exercises are very safe but, as with all forms of physical exercise, it is prudent to consult your doctor before starting Pilates sessions.


    These sessions are not a substitute for medical counselling or treatment. If you have any doubts about the suitability of the exercises, you should refer back to your medical practitioner.

    The teacher can accept no liability for personal injury related to
    participation in a session if:

    • Your doctor has, on health grounds, advised you against such exercise
    • You fail to observe instructions on safety or technique
    • Such injury is caused by the negligence of another participant in the class/studio

    Exercise should be performed at a pace which feels comfortable for you. Pain is the body’s warning system and should not be ignored. Please inform your teacher immediately if you feel an discomfort during a session. Please also inform your teacher if you felt any discomfort after a previous session.

    I understand that Body Control Pilates exercises involve hands-on correction and I hereby consent for my teachers to work in this way.


    I confirm that I have read and understood the above advice and that the information I have given is correct.


    I confirm that My Local Pilates may use the contents of this form, and any other information I may later provide, for teaching purposes, and that this information:

    • will be used in confidence and stored securely
    • will not, in any circumstances, be shared with a third party without my written consent, unless that party is another (Body Control) Pilates teacher who will teach me
    • may be retained by the teacher for a period of time such as complies with professional, legal and insurance requirements that they must fulfil

    I confirm agreement for My Local Pilates to email me directly with information on classes e.g. to advise changes to class times and teachers scheduled. My Local Pilates may contact me via email me until my account becomes inactive. i.e. I choose not to book a subsequent term or Class Pack. Subscription to the monthly Newsletter (sent via MailChimp) is an Opt-in preference. I understand that I have the right to unsubscribe from the newsletter at any time. 

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: