Client In-Take Form
Please complete each question on this form as best you can. Sign the statement at the bottom. If you have any questions, please do not hesitate to ask.
Email address *
Name (First Last) *
Your answer
Phone Number *
Your answer
Do you want to receive text message reminders? *
Do you want to receive email reminders? *
Age *
Your answer
How did you hear about Liturgy Pilates? Check ALL that apply. *
I would like to receive email updates about the latest offerings (including deals!) from Liturgy Pialtes. *
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