Reformer Pilates Health Intake
We are thrilled that you are beginning (or continuing) your Reformer Pilates journey with us! This will help us to have an idea of your goals, your limitations and how we can best support you.

Prior to your first session, please review our Reformer FAQ page so that you are aware of our policies and procedures.

We look forward to seeing you very soon!

Be your best self,
Debra and the DYP Family

Email address *
Today's Date *
Your answer
First & Last Name *
Your answer
Emergency Contact (name & phone number) *
Your answer
Overall Health *
Additional health notes you'd like to share
Your answer
List any current medications (N/A if none apply) *
Your answer
Do you have your doctor or PT's permission to exercise? (If no, please explain) *
Your answer
Have you had any surgeries or injuries in the past year? If yes, please describe.
Your answer
Frequency of physical activity *
Please list your current physical activities *
Your answer
Pilates goals - check all that apply *
Required
Do you currently experience or have you experienced any of these conditions in the past? *
Required
Please list any areas of your body where you currently feel pain, tension or soreness
Your answer
If you are currently seeing a PT or physician, please provide their contact information
Your answer
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