This form will be used to provide me with further details regarding your health and well being, it is an essential tool for us both to chart your progress and for you to get the most from your pilates sessions.

Please complete this online Initial Consultation Form,  prior to your appointment.
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Activity / Occupation

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Previous Medical History









General Information









Your visit today

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Declaration

I have read, understood and completed this form. 
I confirm I am voluntarily engaging in an acceptable level of exercise, and my participation may involve a risk of injury.

Any questions I had were answered to my full satisfaction. I will inform the instructor of any new or unusual symptoms; changes in my medication; results of any investigations or treatment.  

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Date Field