Client Information Form
Let us know more about you so we may assist you better.
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Email *
Name *
Email *
Address *
Phone number
Date of Birth
How did you hear about my studio? Who referred you?
Do you have any injuries, aches & pains (recent or old)? Please describe. If so, have you been given the Ok to exercise from a Doctor or Physiotherapist?
Do you have any health concerns? (eg. asthma, diabetes, high blood pressure,Medications, Osteoporosis etc.)
Are you presently doing other kinds of therapy? (eg. massage, physio, chiropractic)
Are you currently active in any sports, exercise programs physical activity? Please describe.
Have you had any past training in the Pilates method of movement? If yes, where?
Have you any past training in The MELT Method? If Yes, which whom? When did you start?
What is your occupation? What does your typical day involve physically? (eg. sitting at computer, lifting, driving, holding children etc)
What are you goals? What do you want most from this Session or program?
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