Open Day Screening Form

How did you hear about us: Website/Advertisement/Friend/Google/Client/ other:


Please answer the following questions as fully as possible to ensure that your workout is as safe and effective as can be.

1a. Have you had any injuries, aches or pains in the past (please state):

1b. Do you have any injuries, aches or pains currently (please state):

1c. Have you seen a Doctor, Physiotherapist or other healthcare professional regarding these conditions? If so, what was their diagnosis:

1d. Have you been cleared by them to start Pilates classes?

2. Do you have any other health concerns? (e.g. asthma, diabetes, high blood pressure)

3. Are you on any medication?

4. Are you active in any other sports or exercise programmes?

5. Have you done Pilates before? If so, was it matwork, equipment or both and at what level?

6. What would you most like to see an improvement in as a result of this exercise programme? (i.e. posture, strength, flexibility)

7. What is/was your occupation? What does your typical day involve physically? (e.g. sitting at computer, lifting)

Signed:

Date: