Pilates Health Questionnaire & Consent Form
PRIVATE AND CONFIDENTIAL
GENERAL CLIENT DETAILS FOR ONLINE AND STUDIO CLASSES
Client name *
Date of Birth *
MM
/
DD
/
YYYY
Email address *
PILATES AIMS
Have you done Pilates before? *
What aspect of your health would you like to concentrate on? *
ARE YOU CURRENTLY EXPERIENCING ANY OF THE FOLLOWING CONDITIONS?
Low Back Pain *
Pelvic Pain *
Any other spinal conditions *
Do you have pain or restricted movement in any of your joints? *
Heart Problems *
High or Low Blood Pressure *
Epilepsy (Grand Mal Seizures) *
Continence concerns *
PREGNANCY
Are you pregnant? *
Have you had any complications with your pregnancy? *
SURGERIES OR INJURIES
Have you had major surgery in the last 10 years? *
Have you had minor surgery in the last 2 years? *
Have you had any injuries in the last 2 years? *
P3 PILATES PARTICIPATION INFORMED CONSENT SHEET
Please advise us before commencing any session if for any reason, your health or ability to exercise changes.

It is inadvisable to do Pilates between 8 to 14 weeks of pregnancy, unless by special arrangement with your teacher. It is also wise to wait 6 weeks after the birth before resuming exercise.

Pilates exercises are very safe but, as with all forms of physical exercise, it is prudent to consult your doctor before starting Pilates sessions.

These sessions are not a substitute for medical counseling or treatment. If you have any doubts about the suitability fo the exercises, you should refer back to your medical practitioner. The teacher can accept no liability for personal injury related to participation in a session if:

- your doctor has, on health grounds, advised you against such exercise
- you fail to observe instructions on safety or technique
- such injury is caused by the negligence of another participant in the class/studio

Exercise should be performed at a pace which feels comfortable to you. PAIN is the body's warning system and should NOT BE IGNORED. Please inform the teacher immediately if you feel any discomfort during a session. Please also inform the teacher if you felt any discomfort after a previous session.

I understand that Body Control Pilates exercises involve hands-on correction where possible and I hereby give my consent for my teachers to work in this way.
I consent that I have read and understood the above advice and that the information I have given is correct. *
Required
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy