Age

Height

Weight

Email Address

Address

Phone Number

What is your occupation?

Describe your typical day

e.g. are you standing/sitting/driving/lifting etc

Any allergies/intolerances?

Do you have any muscle, joint, nerve, neck or back issues or any other underlying conditions?

Please describe them in as much detail as you can (include recent or old) or n/a if not applicable

If you are female, are you currently pregnant or have you ever had children?

If yes, please state number of weeks pregnant or age of children

If other, please specify the condition:

Are you on any medications that we need to know about?

What is the name and address of your doctor / GP ?

Have you ever had a DXA scan for bone density?

If yes, please let us know your T-Scores and if you are on treatment or not

Are you presently attending any other types of therapy? E.g. physiotherapy, osteopathy, chiropractic or orthopaedic or lymphatic massage?

Please provide their contact details below

Are you currently, or have you ever been, active in any sports, exercise programs or physical activities?

Please describe in detail

*You only need to complete next questions if taking part in pilates programme*

FOR PILATES CLIENTS ONLY

Have you ever had any past training in the Pilates method of movement?

If yes, please tell us where and to what level and if Matwork or apparatus

If other, please state your goal:

health screen form