Your Name: (required)
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Date of Birth:
All information will be treated in the strictest confidence. Please answer all of the questions below. Indicate your answer by ticking either Yes or No.
Will this be the first time you've practised Pilates? Yes No
Do you have any health problems? Yes No
Please briefly outline what health problems you may have, please indicate whether you have high blood pressure, had major surgery in last 6 months, suffer from headaches, backache or have dizzy spells. If you have no health problems, please type "no".
Are you taking any drugs or medication that may affect your ability to exercise? Yes No
Why did want you take up Pilates?