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Pilates Intake Form
First name
*
Last name
*
Email
*
Phone
Birthday
*
Month
Day
Year
Height
*
Sleeping Position
*
Right or Left Hand Dominant?
*
Have you practiced Pilates on a mat or equipment? If yes, please describe your experience. Please list all physical activities you participate in regularly.
*
Please list any physical limitations or chronic illness(es) that may prevent you from some exercises (e.g. uncontrolled high blood pressure, etc).
*
Please list any accidents, injuries or surgeries you have had with dates, prescription and over-the-counter medications you take regularly, and confirmed medical diagnoses from a licensed physician.
*
Please inform your instructor if you experience any feelings of pain or discomfort at any time during your session. Your safety and personal comfort are important to us.
Our instructors may want to adjust your alignment during a class. Are you comfortable with hands-on adjustments?
Yes
No
What are your pronouns?
Submit
Pilates Intake Form
First name
*
Last name
*
Email
*
Phone
Birthday
*
Month
Day
Year
Height
*
Sleeping Position
*
Right or Left Hand Dominant?
*
Have you practiced Pilates on a mat or equipment? If yes, please describe your experience. Please list all physical activities you participate in regularly.
*
Please list any physical limitations or chronic illness(es) that may prevent you from some exercises (e.g. uncontrolled high blood pressure, etc).
*
Please list any accidents, injuries or surgeries you have had with dates, prescription and over-the-counter medications you take regularly, and confirmed medical diagnoses from a licensed physician.
*
Please inform your instructor if you experience any feelings of pain or discomfort at any time during your session. Your safety and personal comfort are important to us.
Our instructors may want to adjust your alignment during a class. Are you comfortable with hands-on adjustments?
Yes
No
What are your pronouns?
Submit
Log In
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