This form is designed to help us gather more information about you. It
is completely confidential and is not used as a diagnostic tool. Please
answer the questions as completely as possible.
Please give details of two people whom we may contact in case of emergency
Please list in the box below any health problems you suffer, not already
mentioned, that may affect your ability to exercise. If you have answered
YES to any of questions 3-16 above, we advise that you consult with your
medical practioner before you start Pilates classes. Please give further
relevant details below, in confidence, to any questions marked YES.
Are there any factors that your teacher should be aware of that may prevent
you from regularly attending classes (such as child care, lack of transport,
Please advise us before commencing any session if, for any reason, your
health or your ability to exercise changes.
Pilates exercises are very safe, but as with all forms of physical exercise,
it is prudent to consult your Doctor before starting Pilates sessions.
These exercises are no substitute for medical counselling or treatment.
If you have any doubts about the suitability of the exercises, you should
refer back to your medical practitioner. The teacher can accept no liability
for personal injury related to participation in a session if:
- Your doctor has not given you medical clearance to exercise/to continue
- You fail to observe instructions on safety and technique
- Such injury is caused by the negligence of another participant in the
The exercises, and the transitions between exercises, should be performed
at a pace which feels comfortable for you. PAIN is the body's warning
system and should not be ignored. Please inform your teacher immediately
if you feel any discomfort, dizziness, nausea or pain during the session.
Please also inform the teacher if you felt any discomfort after a previous
By clicking on the 'Submit' button below, you confirm that you:
- understand that Pilates involves hands-on correction and you give consent
for your teachers to work in this way.
- accept that you remain ultimately responsible for your own health and
- have read and understood the advice above and the information you have
given in this form is correct and applicable to you.
Please click the submit button once and wait for confirmation message