Medical Form

We want to take the upmost care to make sure Pilates works for you. Please fill in this medical form to ensure we know as much about you as possible.

Name

First Name

Last Name

Contact number

Date of birth

Do you have any present injuries, aches/pains or health conditions which you take medication for ?

Do you have any back pain. If so, please describe.

Are there any other health concerns you would like to share that may impact on you taking part?

Do you take part in any other physical activity or exercise programme ?

What is your experience of pilates?

What would you most like to get out of the class?

Is there anything else that is useful to know?

Acknowledgement of Risk and Waive of Liability

When taking part in this exercise programme, I have been asked whether I am taking any medication or have any limitation which may make it unsafe for me to take part. I understand when commencing the classes, I will be asked to sign this statement, agreeing not to hold the instructor responsible for any bodily injury or property damage that may occur during this time. GDPR: Judy Drew will not share your personal data with anyone. It will be stored securely and privately and you have the right to remove this form at any time. It will be deleted once you leave the classes.