Seed Pilates + Movement Training is meant to be a safe and welcoming space for all bodies to exlopre a movement practice free of judgement.

To assist me in estabilshing successful programing for your appointment in a way that will honor your needs and interests, please answer the following questions to the best of your ability.

Name

First NameLast Name

Pronouns

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

MonthDayYear

While Pilates is a movement based practice, no system of our body functions in isolation. With that in mind, please list and explain any previous or current injuries, accidents, illness and/or conditions that may be relevant to your Pilates practice, including any chronic/persistent pain and/or injuries:

If you have structural conditions and/or movement difficulties that may impact your Pilates practice, please explain here (ex. Osteoporosis, Scoliosis, leg length discrepancy, etc):

If currently undergoing medical treatment, please explain here:

List of allergies, if any:

Rate your familiarity with Pilates:

What is your interest in Pilates and what goals do you have for your Pilates practice?

Occasionally, gentle tactile feedback can be a useful tool. Before any use of tactile touch, I will always ask for consent, and will make it clear what part of the body I intend to touch and why. Area's of touch may include shoulders, back, hips, knees, and feet; area's that will never be touched include the chest and genital regions, along with any other areas you do not wish to receive touch. Allowing the instructor to touch your body is not a requirement and you are able to reject the request at anytime, and for any reason. To help me better understand your desires around this, please respond the following questions as honestly as you feel able to.

Which of the following best describes you?

Additionally, please let me of any areas of the body you would not like to be touched and/or if you have any triggering words or movements I can avoid using.

Do you have any accessibility needs? If yes, please let me know here - Note that I try to the best of my ability to create access for all, but I will let you know if I am not able to accommodate something you need.

Any additional information you'd like to share with me?

Should anything change from what has been submitted on this form, please be sure to let me know. This will allow for us to make appropriate adjustments to you programing.

Student Questionnaire

Seed Pilates + Movement Training is meant to be a safe and welcoming space for all bodies to exlopre a movement practice free of judgement.

To assist me in estabilshing successful programing for your appointment in a way that will honor your needs and interests, please answer the following questions to the best of your ability.