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Medical and Lifestyle Questionnaire.

This form must be completed in full. We rely on you to provide us with all relevant information for your safety and in order to provide the best possible service.

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If you answer YES to any of the below health questions please consult with your medical practitioner before you start Pilates Classes.

Do you have a history of anynof the following medical condictions?
Are you currently taking any medication?
Have you ever had any major or minor surgery in the last 10 years?
Do you ever or have you ever suffered from back or neck pain?
Do you have any other pain or restricted movements in any other joints?
Have you ever been diagnosed as hypermobile?

Liftystyle

Do you exercise regularly?
Which type of classes have you attended?
Have you been referred to Pilates by a specialist practitioner?
Do you hereby give us permission to contact them?

Thanks for submitting!

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