You have indicated that you do, or might have an injury or illness that may restrict your ability to do a Studio Pilates class. Please outline the relevant information below and provide as much detail as you can.

Your information will be securely kept in the strictest confidence and shared only with the instructors that are required to know this information to be able to help you. 

 

Choose Your Studio Location: 
First Name:  *
Surname:  *
Email:  *
Phone:  *
Do you have any health or medical problems? Eg; Heart Issues, asthma, high blood pressure: Yes
No
Details: 
Do you have any pain of injuries/conditions that may reflect your movements in any way?: Yes
No
Details: 
Are you currently pregnant or have you recently given birth in the last 6 months?: Yes
No
Details: 
Have you had any recent surgeries that we should know about?: Yes
No
Details: 
Please provide any further information that you can so that we can pass the details on to your instructor: 
All the information given is true and correct and I have provided Studio Pilates with all the information about my health and wellness that may restrict my ability to perform a class:  * Yes
I agree that my body is my responsibility and I will let my instructor know if I experience any pain or discomfort during the class.:  * Yes
I acknowledge that if the instructor feels that I am unfit to participate in the workout, they will request I discontinue the workout.:  * Yes