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+(44) 7957 358315

Reformer

Reformer Pilates Health Questionnaire

Health Form for Pilates

First name*

Last name*

Email

Address

Phone

Birthday

Next of Kin and their contact number

Have you done Pilates before. If so, please state whether it has been mat based and/or reformer and for how long.

Which aspects of your health would you like to focus on?

Core Stability

Flexibility

Posture

Strength

Stress Relief / Relaxation

Recommended by Physio

If a Physiotherapist has recommended Pilates, please provide details of associated condition.

What is your occupation?

What sports / hobbies are you involved with?

Please give details of any physical, mental or emotional health conditions you are currently experiencing. Also provide information of medications you are currently taking.

I consent that I am fit to participate in Reformer and Mat based Pilates.

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