New Client Registration Form

Please fill it in before your first visit.

All new clients at the studio will need to complete this short form. You can do this now online or print it here and bring it along to your first appointment.

NAME & SURNAME	YOUR EMAIL
YOUR PHONE NUMBER	YOUR DATE OF BIRTH
YOUR OCCUPATION	SPORTS/HOBBIES
YOUR ADDRESS	DOES YOUR WORK/SPORT INVOLVE ANY OF THE FOLLOWING? Sitting for long periodsDrivingBendingLifting Heavy WeightStandingAny other repetitive action
NAME & SURNAME OF YOUR EMERGENCY CONTACT	PHONE NUMBER OF YOUR EMERGENCY CONTACT
THEIR RELATIONSHIP TO YOU	HAVE YOU DONE PILATES BEFORE?
DO YOU HAVE ANY HEART DEFECTS OR CONDITIONS?	DO YOU SUFFER WITH CHEST PAIN?
ARE YOU OR COULD YOU BE PREGNANT?	DO YOU SUFFER WITH HEADACHES?
HAVE YOU HAD CHILDREN? PLEASE INDICATE ANY RELEVANT DETAILS THAT MAY INFLUENCE HOW YOU MOVE (POST NATAL CLIENTS)	DO YOU EVER LOSE YOUR BALANCE BECAUSE OF DIZZINESS, SUFFER FAINTNESS OR SIMILAR SYMPTOMS?
DO YOU HAVE HIGH BLOOD PRESSURE?	IS YOUR BLOOD PRESSURE NORMAL OR LOW?
HAVE YOU HAD ANY SURGERY IN THE PAST 10 YEARS?	PLEASE INDICATE ANY MINOR SURGERY
DO YOU SUFFER FROM ASTHMA, DIABETES OR EPILEPSY?	HAVE YOU EVER BEEN TOLD THAT YOU HAVE ARTHRITIC JOINTS, OSTEOPOROSIS OR ANY BONE OR JOINT PROBLEM THAT MAY BE MADE WORSE BY EXERCISE?
DO YOU SUFFER FROM ANY BACK OR NECK PAIN?	DO YOU HAVE PAIN OR RESTRICTED MOVEMENT IN ANY OTHER JOINTS? (e.g. hip, knee, ankle, elbow, shoulder)
ARE THERE ANY MOVEMENTS THAT CAUSE YOU PAIN?	ARE YOU CURRENTLY TAKING ANY DRUGS OR MEDICATION?
HAVE YOU BEEN DIAGNOSED AS HYPERMOBILE? (excessive joint mobility)	HAVE YOU BEEN ASKED BY A SPECIALIST PRACTITIONER TO 'DO' PILATES?
PLEASE INDICATE WHY YOU WANT TO PRACTICE PILATES AND WHAT YOU AIM TO ACHIEVE	WOULD YOU BE HAPPY FOR US TO CONTACT YOUR PRACTITIONER?
HOW DID YOU HEAR ABOUT US?	RECOMMENDED BY A FRIEND? ENTER THEIR NAME SO WE CAN THANK THEM!
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