Screening Form
Please complete and SUBMIT this form as accurately as possible prior to your first session.
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Email *
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Name *
Address *
Date of birth *
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Mobile number *
We Emergency contact NAME and NUMBER *
Occupation *
Estimated percentage of your day spent sitting? *
Do you suffer from any of the following (please tick)? *
Required
Are you currently on any medication? *
If you have answered YES to medication, please give details
Do you suffer with back pain? *
If YES, please give details
Do you have any joint replacements? *
If YES, please give details
Are you pregnant, or have had a child in the last six months? *
In the last 12 months, have you had treatment from any of the following? *
Required
How would you rate your posture? *
Is there any other relevant health information you wish to share? *
If YES, please capture here
Do you require medical clearance to attend Pilates? *
Client Declaration - I accept full responsibility for taking part in Pilates. I choose to do so at my own risk. I understand that it is my responsibility to inform my instructor should any of my medical details change. I understand my Pilates instructor is not medically trained and that if I have queries of a medical nature, I must consult a medical professional and follow their advice. *
Required
Our Terms - We are open 39 weeks per year and spread your membership payments across 12 equal monthly payments for ease.  Our timetable is based on school holidays meaning there is no classes in the summer holidays, however there is still a payment to make.  Any weeks we are closed have been factored into your payments so you are not losing out.  If you miss any face to face classes, we will do everything we can to find a suitable catch up, however this may be an online session.  Should you wish to cancel or change your membership, please give 1 months notice so your space can be filled. *
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