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IMPORTANT: When Emailing Us: Please complete BOTH the contact and screening forms below and send.

If you are contacting us to join our studio, please ensure you complete and submit BOTH the message form and the screening form

Please fill in the below form BEFORE the screening form

Screening Form

Name

D.O.B

Full Address

City

Postcode

Home Tel

Mobile Tel

Emergency Name

Emergency Tel

How did you hear about us: Website/Advertisement/Friend/Google/Client/ other:

Please answer the following questions as fully as possible to ensure that your workout is as safe and effective as can be.

1a. Have you had any injuries, aches or pains in the past (please state):

1b. Do you have any injuries, aches or pains currently (please state):

1c. Have you seen a Doctor, Physiotherapist or other healthcare professional regarding these conditions? If so, what was their diagnosis:

1d. Have you been cleared by them to start Pilates classes?

2. Do you have any other health concerns? (e.g. asthma, diabetes, high blood pressure)

3. Are you on any medication?

4. Are you active in any other sports or exercise programmes?

5. Have you done Pilates before? If so, was it Matwork, Reformer or both and at what level?

6. What would you most like to see an improvement in as a result of this exercise programme? (i.e. posture, strength, flexibility)

7. What is/was your occupation? What does your typical day involve physically? (e.g. sitting at computer, lifting)

I understand the above questions and I have answered them to the best of my knowledge. I agree that I am in good physical condition (except as stated above) and accept that I am taking part in a STOTT PILATES session at my own risk. I understand that whilst the utmost of care is taken that neither individual instructors nor Oxfordshire Pilates will be liable for damage or injury.

Signed:

Date:

Please remember to fill in the message on the previous contact form

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Screening Form

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