Before starting your workouts you must provide your information in the form below. This form helps us to help you and fast tracks the commencement of your Studio Pilates International workouts.

All fields with a * must be filled out. If you leave one of these fields blank you will need to fill the entire form out again so please take your time.

We respect your privacy so the information you provide will be kept confidential. After completion, please check your email for further instructions. If you have any questions please call 07 3899 4555.

I am:	Female Male
Age:
*First Name:	*
*Last Name:	*
*Email:	*
*Phone:	*
*Street Address:
*Suburb:
*Post/Zip Code:
*Have you had or are you currently suffering from any of the following:	Heart Problems High Cholesterol Epilepsy Lung Problems Diabetes Pelvic floor issues Asthma None of the above
*Do you or have you suffered from any medical conditions other than the ones listed here?:	Yes No
If so please provide details:
*Have you had major or recent surgery?:	Yes No
If so please provide details:
*Are you currently pregnant or recently given birth?:	Yes No
If so please provide details:
*Do you have any current pain or injuries?:	Yes No
If so please provide details:
If you do have a current injury, how would you rate your pain (10 is maximum):	0 1 2 3 4 5 6 7 8 9 10
Are you currently seeing anyone for this condition?:	Yes No
If so, who?:
*Have you had any serious injuries in the past?:	Yes No
If so please provide details:
Your main aim for doing Pilates is:	Tone up Firm up Lose weight Strengthen my body Improve my posture Enhance my sport Stay well Improve an injury Strengthen my pelvic floor Many of these resons
Do you have a specific goal you want to achieve?:
Do you have a date by which you want to achieve this goal?:	dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31mm 01 02 03 04 05 06 07 08 09 10 11 12yyyy 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
What will it mean to you if you achieve this goal?:
What priority do you place on your health? :	High Medium Low
Do you currently exercise? If so please provide details:
	I acknowledge that I must be courteous to other members by managing my bookings online and if I cancel with less than 12 hrs or I fail to show up I will forfeit my payment or be charged a cancel fee