Enrolment Form Copy

Your Name (required)

Your Address

Your Phone Number

Your Mobile Number

Your Email (required)

Have you done Pilates Before?

Which Class are you enrolling for?

Has your Doctor ever said that you have any sort of heart trouble or defect?

Have you ever been told that you have arthritic joints or any bone or joint problem that may be made worse by exercise?
 Yes No

Is your blood pressure
 High Low Normal

Are you pregnant or have you had a baby in the last 12 months?

If you have children, have you had a caesarean?
 Yes No

Have you had any operations or injuries in the last year? If so, please explain if relevant.
 Yes No

Do you suffer from backache? If so, please explain.
 Yes No

Have you ever been given any remedial exercises? If so, can you briefly describe them?
 Yes No

Have you been referred by a GP, Physiotherapist or any other practitioner.

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