Salty Dog Yoga & Surf Reformer Private Session Form
All information is confidential and used solely to ensure your safety and the effectiveness of your Pilates sessions
Email *
Name *
Phone number *
Date of birth *
Emergency contact name and phone number *
Reformer sessions are usually scheduled on Monday and Wednesdays but we may be able to schedule another day.  What times and days are you available?

Medical History

Please answer the following questions honestly and to the best of your knowledge:

Do you have any of the following conditions?

 *
Required
Are you currently under medical supervision or physical therapy? *
Are you currently taking any medication that may affect your physical activity? *
Do you experience any chronic pain or limitations during movement? *
Have you ever been advised by a doctor not to exercise? *
What is your Pilates experience? *
If yes how long have you been practicing Pilates? *
Required
How frequently do you currently exercise (of any kind)? *
Required
What are your main goals for practicing Reformer Pilates? (check all that apply) *
Required
Are there any movements or positions you find uncomfortable or are advised to avoid? *
Required
If you answered yes please explain *
Do you have any specific concerns or expectations from your Pilates sessions? *
Policies and cancellation: By checking the box I am certifying that I have cleared any new form of physical exercise with my doctor.  I am aware of the 24 hour cancellation policy and that if I do not cancel during that time period I will be charged for the full service. *
Required
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