Grove Pilates client enquiry form Question Title * 1. Name Name * Occupation * Address Address 2 City/Town Post Code * Email Address * Phone Number * Question Title * 2. We will provide the best teacher for you. As some of our teachers specialise in different areas please provide all the information you can. Do you have any injuries or particular tension you are looking to resolve? Question Title * 3. What is the best day/time for you. For more specific times such as before or after work please let us know in the comments box Monday am Monday pm Tuesday am Tuesday pm Wednesday am Wednesday pm Thursday am Thursday pm Friday am Friday pm Saturday am Saturday pm Sunday am Sunday pm Other (please specify) Question Title * 4. What is your daily lifestyle of movement i.e. are you working at a desk? Are you working from home attempting to be comfortable? Are you a mum? Please let us know anything that maybe relevant to your movement. Question Title * 5. What are you looking to achieve from starting a Pilates practice? Question Title * 6. Have you practiced Pilates before? No Yes, a little Yes, a lot Yes, but a long time ago Question Title * 7. Would you like mat Pilates or reformer Pilates? Mat Pilates Reformer Pilates Unsure Question Title * 8. Do you have a timeline that you are looking to be in great shape for, such as a summer coming up or a wedding, or a sports activity? Question Title * 9. Please let us know if you suffer with any of the following conditions that may affect how you move Heart defect or heart trouble chest pain during exercise high blood pressure low blood pressure feelings of dizziness or feeling faint when you exercise frequent headaches asthma diabetes arthritis osteoporosis osteopenia bone or joint problems I am taking medication that may affect my ability to move (please add details below) Other (please specify) or details Question Title * 10. For women only: are you pregnant? Yes (please give details of how many weeks and any pregnancy related issues you may have) No Pregnancy details Question Title * 11. Have you been through anything that may have had an impact on your pelvic floor/core health? Such as pregnancy, a hernia, c-section, abdominal surgery, abdominal muscle separations Question Title * 12. Following your assessment do you know if you would like to attend group classes or further private sessions? group mat classes group reformer classes private sessions semi-private sessions unsure, will follow recommendations Question Title * 13. Your safety and welfare are of paramount importance to Grove Pilates. Grove Pilates and the teacher will do all that is reasonably possible to ensure your safety in class and the safety of your personal belongings. In stating my name/signing I agree to inform the teacher or therapist of any injury that may affect my participation in class and understand that Pilates exercises may involve hands-on corrections and am happy for the teacher to work in this way. I understand that classes at times may be physically strenuous and I voluntarily participate in them with full knowledge that there is risk of personal injury. I agree that Grove Pilates is ultimately not responsible for injury or my personal belongings while I attend a class. If you agree please state your name Done