Studio Flo

Reformer Pilates Health Questionnaire & Consent Form

Please complete this form prior to attending your first session. All information provided will remain confidential.

Personal

Health

Pilates

Waivers

Sign

Client Information

Full Name *

Date of Birth *

Phone Number *

Email Address *

Emergency Contact Name & Number *

Occupation (optional)

Has your Doctor ever advised against exercise?

Do you suffer from heart problems?

Do you suffer from high blood pressure?

Do you experience any dizziness, fainting or chest pain during exercise?

Have you had any surgery in the last 12 months?

Do you have any back, neck, joint or muscular injuries?

Are you currently pregnant?

Have you given birth within the last 6 months?

Do you have Osteoporosis or low bone density?

Are you currently taking medication that may affect exercise?

Do you have any medical conditions and or injuries we should know about? If yes, please provide details:

Have you done Pilates before?

Have you done Reformer Pilates before?

What are your goals for Pilates? (Select all that apply)

Improve strengthImprove postureRehabilitationFlexibilityStress ReliefWeight Management

I confirm that the information provided is accurate to the best of my knowledge.
I understand that participation in reformer Pilates involves physical activity and carries some risk of injury.
I agree to inform the instructor immediately if I experience pain, dizziness, discomfort, or unusual symptoms during a session.
I voluntarily participate and assume responsibility for risks involved.
I release Studio Flo from liability for injuries or damages arising from participation except where caused by negligence.

I understand that cancellations made with less than 24 hours notice may be charged in full.

Initials *

I consent to photographs/videos being taken during sessions for Studio Flo and social media purposes.

Client Signature *

Sign your name here

Date *