Bookings Essential Client Manager

Pilates Tasmania - Create New Account

Email:*

Title:*
First Name:*
Last Name:*
Date of Birth:*
Mobile No.:*
Work No.:
Home No.:
Address 1:*
Address 2:
Suburb:*
State:*
Postcode:*

Other Details

Emergency Contact Name and Number^*

Current Injuries or Restrictions^*

Previous Injuries^*

Medication that may affect your ability to exercise safely?^*

Medical Practitioner & Contact Number^*

List all significant conditions, illness or hospitalisation including stroke, epilepsy, recurring headaches, blood pressure, arthritis, migraine, asthma etc.^*

List any pain or restricted movement in any are of your body including neck, shoulders, back, hips, knees, ankles and other^*

Are you pregnant? If yes, when are you due and list number of pregnancies.^*

What is your current exercise and frequency?^*

What goals do you hope to achieve from attending Pilates?^*

Have you any Pilates experience and where?^*

How did you hear about Pilates Tasmania and what made you choose us?^*

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