Client Enrolment Form

All information submitted will be treated in the strictest of confidence.

Please send a message with this form, so I know which class you would like to attend or if you would like to book a 1-2-1.

General enquiries, please use contact form on other page.

    Personal Details:

    Full name:

    Address:

    Contact number:

    Email address:

    Sex:

    Occupation:

    Sports, Hobbies:

    Emergency Contact Details:

    Full name:

    Contact number:

    Email address:

    Your Background & Your Health

    1. Does your work / sport involve any of the following?

    Sitting for long periodsBendingLifting heavy weightsDrivingStandingAny other repetitive action

    2. Will this be the first time that you have practised Pilates?

    YesNo

    If NO, have you previously attended:

    StudioBody Control Pilates Matwork classesOther Pilates MatworkAt home (book/dvd)

    Number of classes attended previously:

    0-55-1010-2020+

    3. Has your doctor ever said that you have any sort of heart trouble or defect?

    YesNo

    4. Do you feel pain in your chest when you undertake physical activity?

    YesNo

    5. Are you, or could you be pregnant right now?

    YesNo

    If yes, when is your due date?

    6. Have you been pregnant in the last six months?

    YesNo

    7. If you have had a baby, how was it delivered?

    NormallyCaesereanNormally with intervention (e.g Forceps)

    8. Do you often get headaches?

    YesNo

    9. Do you lose your balance because of dizziness or do you ever lose consciousness, feel faint or dizzy?

    YesNo

    10. Do you have high blood pressure?

    YesNo

    11. Is your blood pressue:

    NormalLow

    12. Have you had major surgery in the last ten years?

    YesNo

    13. Have you had minor surgery in the last two years?

    YesNo

    14. Do you suffer from asthma, diabetes or epilepsy?

    YesNo

    15. Have you ever been told you have arthritic joints, Osteoporosis, Osteopenia or any bone or joint problem that may be made worse by exercising?

    YesNo

    16. Do you suffer from back or neck pain?

    YesNo

    17. Do you have pain or restricted movement in any other joints (e.g hip, knee, ankle, shoulder)?

    YesNo

    18. Have you ever been diagnosed as hypermobile (excessive joint mobility)?

    YesNo

    19. If you have answered 'yes' for questions 14-18, do you have medical permission to exercise?

    YesNo

    20. Are there any movements that cause you pain?

    YesNo

    21. Are you taking any drugs or medication which may affect your ability to exercise?

    YesNo

    22. Have you ever been recommended to take up Pilates by a specialist practioner?

    YesNo

    If YES, by your:

    GPPhysiotherapistChiropractorOsteopathOther

    23. Do you hereby give us permission to contact them?

    YesNo

    Your Aims

    24. What are your reasons for taking up Pilates?

    25. What health or physical goals would you like to achieve over the next three months?

    26. What longer-term health or physical goals would you like to achieve over the next 12 months?

    Part 3 - 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. The teacher can accept no liability for personal injury related to participation in a session if:

    • Your doctor has, on health grounds, advised you against such exercise

    • You fail to observe instructions on safety or technique

    • Such injury is caused by the negligence of another participant in the class/studio

    Exercise 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 during a session. Please also inform your teacher if you felt any discomfort after a previous session.

    I understand that Body Control Pilates exercises involve hands-on correction and I hereby consent for my teachers to work in this way.

    Please ensure you read my terms and conditions - read now.

    I confirm that I have read and understood the above advice and that the information I have given is correct.I confirm I have read and accept the terms and conditions