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Pilates Client Form
In the interest of participant safety if you are new to the clinic classes please fill out this form before attending the class.
First Name
*
Surname
*
Address
*
Email
*
Phone
*
Are you taking medication?
Are you taking medication?
Yes
No
If so, what medication?
If so, what medication?
Do you suffer from any of the following?
Do you suffer from any of the following?
Asthma
Cardiac Issues
Musculoskeletal Injury
Epilepsy
Diabetes
Other Health Issue
None
Other health issues
Other health issues
You agree to inform the pilates instructor if you are pregnant or suffering from a serious medical illness or condition
*
You agree to inform the pilates instructor if you are pregnant or suffering from a serious medical illness or condition.
Yes
You agree to the terms & conditions
*
You agree to the terms & conditions.
Yes
Home
Physio
Sports Injury
Aches and Pains
Child & Adult Orthotics
Womens Health
Vertigo & Vestibular Rehabilitation
Specialist Clinics & Consultant Referrals
Posture & Ergonomics
Other Services
Pilates
Class Types
New Client Form
Book Your Class
Team
Prices
Testimonials
Contact Us
Book an Appointment
091589696