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Health Form

Keeping You Safe and Sound

The Final Step to Complete Your Course Registration

Before you can start on your first course with Pilates4life, we need to learn more about your health history. We take your safety very seriously.

If you are a current member you can also use this form to update us on a change in your health details.

Health Form – What’s that for?

A course with Pilates4life is more than just attending a class – it’s a whole education, with loads of support to help you get the most from the experience. To help us deliver the best course for you we ask that you complete the Health Form below. Unlike many health clubs and salons, we read every form and use it to prepare for your first class – anticipating potential problems and devising modifications to make things smoother and easier.

Confidentiality

Your issues stay confidential and we can discuss them privately and in more detail

Personalised Adaptations

We can tailor exercises to match your capabilities and suggest extra work to improve areas of weakness

Ensures Safety

Your safety is our top priority, so you can relax and know that we’re looking out for you

Maximises Teaching Time

Class time is precious – it’s for learning and practising – not form-filling and admin

Important Notice

  1. Always consult your doctor or health professional before undertaking a new exercise regime.
  2. This Health Form must be completed in full and submitted at least 1 working day before the start of your course.

Health Form

First Name

Email

Last Name

Who Should We Contact in Case of Emergency?

Medical Issues
  1. Have You Had Surgery in the Last 10 Years? YESNO
  2. Have you suffered, or do you suffer, from any of the following:
    AsthmaDiabetes (Type 1)Diabetes (Type 2)EpilepsyHigh/Low Blood PressureFainting/Dizziness/HeadachesHearing LossJoint ProblemsBack ProblemsArthritisHeart Condition
  3. Are You Pregnant? YESNO
  4. Please outline any other conditions which may affect your ability to exercise
Daily Activities


Declaration

I acknowledge that I am fully responsible for:

  1. monitoring my capability to participate in any exercise session
  2. advising Pilates4life of any health or medical conditions that may affect my participation

I have answered the questions accurately and to the best of my ability:

I understand the contents of this questionnaire:

Keeping You Safe & Sound