top of page

CONFIDENTIAL HEALTH FORM

Please fill out the below ahead of doing a Group Class or Private Session for the first time

PERSONAL DETAILS

EMERGENCY CONTACT DETAILS

YOUR BACKGROUND AND HEALTH

1. Does your work or hobbies involve any of the following?
2. Have you done Pilates before?
3. Has your Doctor ever said you have sort of heart trouble or defect?
4. Do you feel pain in your chest when you undertake physical activity?
5. Are you, or could you be pregnant?
6. Have you been pregnant in the last 6 months?
7. If you've had a baby how was it delivered?
8. Do you often get headaches?
9. Do you lose your balance because of dizziness, or do you ever lose conciousness, feel faint or dizzy?
10. Do you have high blood pressure?
11. Is your blood pressure...
12. Have you had major surgery in the last 10 years?
13. Have you had minor surgery in the last 2 years?
14. Do you suffer from Asthma, Diabetes or Epilepsy?
15. Have you been told you have Osteoporosis, Osteopenia, Arthritis, or any bone or joint problem that may be made worse by exercising?
16. Do you suffer from back or neck pain?
17. Do you have any pain or restricted movement in any other joints, or are there any movements that cause you pain?
18. Have you ever been diagnosed as hypermobile or hypomobile?
19. Are you taking any drugs or medication which may affect your ability to exercise?
20. Have you been recommended you take up Pilates by a specialist practitioner?
Do yo give us permission to contact them?

YOUR AIMS

IMPORTANT INFORMATION

Please advise us before commencing any session if, for any reason, your health or your ability to exercise changes.

 

It is inadvisable to do Pilates between weeks 8 to 14 of pregnancy, unless by special arrangement with your teacher. It is also wise to wait six weeks after the birth before resuming exercise.

 

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 sessions are not a 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.

THANK YOU FOR COMPLETING THE FORM

bottom of page