Pilates Health Questionnaire

PILATES HEALTH QUESTIONNAIRE

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?

Terms of Booking

If you ticked one or more questions talk to your doctor before you start becoming more physically active. Tell your doctor about the questionnaire and which question(s) you ticked. Talk with your doctor about the Pilates Classes you wish to participate in and follow his/her advice.

If your health changes so that you subsequently would tick any of the above questions, please inform me immediately.

You participate in the Pilates exercises at your own risk and if you suspect any adverse affect brought on by your participation, you will immediately report such to me.

I have read and agree the above Terms of Booking.

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

I consent to Michelle contacting me by email to provide updates about Pilates classes.

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