New Client Form

Breathe Classical Pilates & Rosalie Sevell Pilates New Client Form
Name

First NameLast Name
Date of Birth

DayMonthYear
Date
E-mail*
example@example.com
Lifestyle & Goals
Does your work involve any repetitive movements or prolonged postures? If yes, please describe:
What sports and hobbies are you involved in and how often do you participate in them?
Do you have any previous Pilates experience?
What would you like to achieve from Pilates?
Health Questionnaire
Please complete this section to help the teacher prepare for your session. Exercises will be chosen based on your health history and range of motion observed in the session. All questions are compulsory, so please write 'N/A' or 'none' if not applicable.
Some medication may play a role in affecting movement. Please list any medications you’re currently taking:*
Please list operations and/or procedures you've had, with dates:*
If you've suffered any injuries recently or have medical conditions that affect movement, please list them:*
Prenatal Policy: We have teachers trained in prenatal Pilates but we ask for Doctor's approval before attending. Private 1:1 sessions are recommended, so sessions can be tailored to specific needs and the client is able to be closely monitored.
Are you pregnant or trying to conceive?*
Have you ever given birth? Please provide details, including the year of birth and whether it/they were a C-Section or natural birth. *
Pilates Exercises and your responsibilities: You will perform a number of exercises within each session. The intensity of each will be at a level appropriate to your ability, and to the level of the certification held by the teacher. You must disclose information about your health status or previous experiences of unusual feelings during physical effort. Immediate reporting of any feelings of effort or discomfort during the exercises is of great importance: it is your responsibility to fully disclose such information when requested or as you experience such feelings.

Every effort will be made to ensure the exercises performed are suitable for you and your range of motion based on your health history and observations made during the sessions.
Marketing
We don't send newsletters about studio news and offers often but we'd love to be able to send you one when we do. Once you're on the mailing list you can unsubscribe at any time.

Please add me to the Breathe Classical Pilates Mailing list
Client informations - 24h cancellation policy
A minimum of 24 hours notice is required to cancel a session or class.

Please cancel or amend your booking by clicking the links on the booking emails or via your Acuity account (if you’ve registered).

We do not accept emails or voicemails as a form of cancellation.

Cancellations made within the 24 hours before the booking will be charged as a Late Cancellation (full fee).

‘No Shows’ will be charged as a Late Cancellation.

Courses are exempt from the 24 hour cancellation policy, as the sessions within the course are non-transferable and non-refundable.
Client Liability waiver
By signing below, you agree to the following statements:

“I understand that sometimes a degree of discomfort can occur when addressing problems in the body through exercising.

I will disclose relevant health and fitness information, inform the teacher of discomfort, pain, tingling or numbness, and I give my consent to participate in physical activity.

I acknowledge this programme of exercise should only be undertaken when in a Pilates session or when I have been given specific instructions to do certain exercises on my own.

I confirm that the answers to the health questionnaire are to the best of my knowledge correct and I will immediately inform you of any changes to my health.

I declare that all and/or any exercises prescribed or administered are undertaken at my own risk. I will not hold Breathe Classical Pilates, Rosalie Sevell Pilates, or any of its teachers responsible for injuries which may arise.

I understand that the information provided within this form and any information shared in sessions will be stored and processed by Breathe Classical Pilates and/or Rosalie Sevell Pilates and the team involved in the administration and delivery of my sessions, as explained in our Privacy Notice.

I agree to abide by the Studio Policies detailed above, including the Cancellation Policy; I understand that I will be charged in full if I do not give 24 hours’ notice when cancelling an appointment."
Signature (touch screen - or use your mouse / trackpad)*

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Breathe Classical Pilates & Rosalie Sevell Pilates New Client Form

Lifestyle & Goals

Health Questionnaire

Marketing

Client informations - 24h cancellation policy

Client Liability waiver