SOP Health Form

Client Registration Form

Every new client will need to complete a client registration form before joining a class. This will only need to be done once upon scheduling your first class, however, if any information has changed since you last attended/completed the form please update your information as deemed necessary. This information is completely confidential.
Contact Details
Name*

First NameLast Name
Home Address*

City

Post Code
Home Number

Area CodePhone Number
Mobile Number*
E-mail*
Emergency Contact Details
Emergency Contact:*

First NameLast Name
Relationship*
Home Number

Area CodePhone Number
Mobile Number*
Personal Information
Gender*
Date of Birth*

DayMonthYear
Lifestyle Information
Occupation
How would you describe your typical day.

SedentaryActivePhysically Demanding
Physical activities/ hobbies including frequency.
Do you have any prior Pilates experience.

YesNo
If yes, how long ago.

What are your AIMS and EXPECTATIONS after following a course of Pilates.

	Tick all that apply
Sense of well-being
Improve Posture
Improve Muscle Tone
Improve Flexibility
Relieve aches & pains
Improve Mobility
Other

If chosen other, please elaborate
How did you hear about us.*
Health Information
Do you have any of the following conditions? Please tick all that apply.

High Blood PressureLow Blood PressureHeart ConditionFainting / DizzinessDiabetesAsthmaBreathing DifficultiesAllergies e.g. latexArthritisOsteoporosisBone FracturesDislocationsSpine ConditionsFibromyalgiaAches & PainsEpilepsyStrokeMultiple SclerosisParkinson's DiseaseCarpal TunnelSciaticaPrenatalPostnatalMenopauseIncontinenceChronic Fatigue e.g. MECancerDepressionImpaired VisionImpaired HearingHeadaches / Migraines
Have you had surgical procedures in the past, recently or a scheduled surgery?*

YesNo
Are you currently taking any medications?*

YesNo
Please list any other conditions not stated above, or provide further details of conditions, surgeries and medications.
Do you know of any reason why you should NOT participate in physical activity?*

YesNo
Have you consulted your doctor before deciding to participate in Pilates classes? (please note that if you have answered yes to many of the above questions we may advise that you seek advice from your doctor before participating in Pilates)*

YesNo
The nature of Pilates involves hands on guidance as means of facilitating precision during exercise. Are you happy for your instructor to use hands on guidance where appropriate. (no hands on during government covid rules)*

YesNo
I confirm that I have read, understood and honestly answered the questions above and I wish to participate in Pilates activities.*

(I agree to terms)
I will work at an appropriate level for myself and stop if I feel pain or discomfort, and inform my instructor.*

(I agree to terms)
I will not attend the studio if I have coronavirus symptoms - a constant cough, high temperature, loss of taste and smell. *

(I agree to terms)
If we need to cancel or reschedule your sessions we will contact you either by email or call/text. Are you happy for us to keep in touch with the occasional newsletter to keep you informed of new classes, workshops, etc?*

YesNo
Your Personal Data will be used by Spirit of Pilates to identify you and enable us to provide an enhanced Pilates experience tailored to you. No information will ever be disclosed to a third party without your consent.*

(I agree to terms)
Signature*

Clear
Date*

DayMonthYear
Should be Empty:

Client Registration Form

Contact Details

Emergency Contact Details

Personal Information

Lifestyle Information

Health Information