Health & Fitness Profile Form

Please take a few moments to complete or update your fitness profile. All information supplied will be treated in strictest confidence, as outlined in our privacy policy.

Name *

Date of birth

Occupation

How did you hear about us?

Have you done pilates before? *

No
Yes

Where have you previously done pilates? *

Studio
Gym
Self-taught

Why have you decided to begin pilates? *

Do you do any other sports or exercise? *

No
Yes

What sports or exercise do you do? *

Are you currently experiencing any pain, injuries or discomfort? *

No
Yes

What symptoms are you experiencing? *

Have you had any major or minor surgeries? *

No
Yes

What was the nature of the surgery? *

Do you have arthritis, osteoporosis or any other joint condition? *

No
Yes

What is the nature of your joint condition? *

Have you been diagnosed as being hypermobile? *

No
Yes

Do you experience any discomfort related to being hypermobile (for example, recurring joint injuries and pain, or muscle pain and fatigue etc)? And if so, what is the severity of these symptoms? *

Are you currently pregnant? *

No
Yes

When is your due date? Please select date below *

Tell us a little about how your pregnancy is progressing. For example - Is this your first baby? Are you experiencing any pregnancy-related discomfort? Are you considered high risk? Any other comments? *

Have you recently had a baby? *

No
Yes

Tell us a little about your postpartum journey. For example - Did you have an easy birth? Have you experienced any postpartum discomfort (pelvic floor dysfunction or pain, incontinence, diastasis recti, back / shoulder pain etc)? Have you been cleared to start exercising again? Any other comments? *

Were you referred to us by a medical professional? *

No
Yes

May we contact them? *

No
Yes

Name of medical professional: *

Medical professional email address: *

Medical professional telephone number: *

Any other comments?

Name *

email *

By proceeding, I confirm that I have disclosed all necessary information regarding my health and fitness, and that the state of my health and fitness is such that my participation in a programme of physical exercise is appropriate. *

Yes
No

If you are unsure whether or not you should be exercising, please do not continue with your booking. Please seek advice from your medical professional. We look forward to seeing you once you have been cleared for exercise. *

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