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.  All information provided is CONFIDENTIAL.

Please complete this online Initial Consultation Form, below, prior to your appointment.

In conjunction with completing this form, please also read the relevant Booking Policy for the class that you are taking part in as you are required to agree to these terms, click on the links:

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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.  

NOTE:


Please ensure that you have read and understand the relevant Booking Policy for the class that you are attending, as you are required to agree to these terms when attending a class.

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Date