PRIVATE SESSION BOOKING
Please complete this form for One-to-One and Small Group Booking
BOOKING, HEALTH QUESTIONNAIRE AND AIMS & GOALS
Before you continue with this booking you should review our
Terms of Booking
Day?
Time?
Has your doctor said you have a heart condition and you should only do physical activity recommended by a doctor?

Do you ever feel pain in your chest when you do physical activity?

Have you ever had chest pain when you are not doing physical activity?

Do you ever feel faint or have spells of dizziness?

Do you have a joint problem that could be made worse by exercise?

Have you ever been told you have high blood pressure?

Are you currently taking any medication which we should be made aware?

Are you pregnant or have you had a baby in the last 6 months?

Is there any reason you should not participate in physical activity?

Do you suffer from any condition such as epilepsy or diabetes that we should be made aware of?

List at least 1 specific goal
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I have read and agree the Terms of Booking

I consent to Purely Pilates collecting the information on this form to process my booking.

I consent to Purely Pilates contacting me by email to provide updates on what is going on at our studio.