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Client Information Form
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Email
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Name
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Address
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Phone number
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Date of Birth
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How did you hear about my studio? Who referred you?
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Do you have any injuries, aches & pains (recent or old)? Please describe. If so, have you been given the Ok to exercise from a Doctor or Physiotherapist?
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Do you have any health concerns? (eg. asthma, diabetes, high blood pressure,Medications, Osteoporosis etc.)
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Are you presently doing other kinds of therapy? (eg. massage, physio, chiropractic)
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Are you currently active in any sports, exercise programs physical activity? Please describe.
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Have you had any past training in the Pilates method of movement? If yes, where?
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Have you any past training in The MELT Method? If Yes, which whom? When did you start?
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What is your occupation? What does your typical day involve physically? (eg. sitting at computer, lifting, driving, holding children etc)
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What are you goals? What do you want most from this Session or program?
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