Client Information

Contact Details

Names

Surname

Date of Birth

Age

Email

Cellphone

Home Telephone

Work Telephone

Home Address

Emergency Contact

Name

Contact Number

Relationship

Health

Occupation

Current Stress Level

Gender

Smoker?

Smoker: How Long?

Pregnant?

Pregnant: How Many Weeks?

Previous Pregnancies and Details?

Select the items that apply to you:?
Previous surgical operations.Current, physical condition.Previous or current pain.Previous or current injury.

Details of injuries, pain or physical condition?

Operation Year

Reason for operation?

Operation Year

Reason for operation?

Operation Year

Reason for operation?

Operation Year

Reason for operation?

Operation Year

Reason for operation?

Operation Year

Reason for operation?

Operation Year

Reason for operation?

Physical Activity

How active are you in general?

Exercise at School / College / University?

Have you done Pilates before?

Studio?

How many years?

Studio

What are your goals?

Where did you hear about the Naturally Pilates Studio?

Indemnity

I, , the undersigned, hereby agree to indemnify Jo-Anne Callaghan (ID no: 8006140090084) and studio instructors against any injury or harm during the attendance or participation of any Pilates class.
I agree to indemnify Jo-Anne Callaghan and studio instructors against any claims, proceedings, loses, damages, liabilities, costs or expenses which may at any time be suffered or incurred to myself and or to my belongings whilst on the premises.
I acknowledge that there is a 24-hour cancelation policy on all classes, classes not cancelled in time are forfeited.

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