What is your age? (optional)

Are you on any medication that may affect you during the session?

Have you any illness/disabilities/injuries or joint problems?

Have you been recommended to do Pilates by a health/medical practitioner e.g. Physiotherapist?

Women ONLY: Are you pregnant (or have been) in the last 6 months?

Are there any other conditions that your instructor should be aware of or anything that may affect your ability to exercise?

Briefly, what is your exercise history (i.e. when you last exercised and what activity it was).

What are you hoping to achieve from your class?

If you have answered YES to any of the above questions, we suggest you seek medical approval to continue with your training. Please feel free to mention anything else that I may need to know to keep your session safe both now and as the training progresses. Whilst every effort is made to keep the session both safe and effective there is a risk of injury as with any programme of activity. I am participating of my own free will. On rare occasions, there may be a stand in teacher.

INFORMED CONSENT
By typing my name in the box below, I hereby confirm that I have read, understood and answered honestly the pre-exercise health screening questionnaire.