Longevita New Client Questionnaire
Please take this quick Wellness Questionnaire prior to your first visit to help us learn more about you!
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Email *
What is your first and last name? *
What is your phone number? *
How did you hear about Longevita? *
Which of our classes are you interested in trying? *
Required
Have you ever tried a Pilates reformer class before?
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Look back over your life and please describe the best you’ve ever felt... What were you doing then and who were you doing it with? *
What are your specific health, wellness, and lifestyle goals? *
What are you doing right now to achieve these goals? *
How long do you realistically think it will take to achieve the goals you have in your mind? *
How often do you see yourself wanting to attend classes and/or private sessions with us in pursuit of achieving your goals? *
Historically, what has triggered you to stop your efforts to reach your goals? (This helps us to prevent the same trigger in the future.)
Everyone has something that has the potential to derail their efforts. What obstacles do you foresee standing in your way? *
Required
Do you have aches or pains in any parts of your body? Any Injuries that you're working to heal in your classes with us? Any neurological conditions such as MS or Parkinson's Disease? *
Just one last question, if you can imagine what your life will look like when you achieve your aforementioned goals, how will you feel? How will your life change? What will you do? *
Anything else we should know?
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