Caring for the body you live in

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You’ve decided to join the Pilates family!

 

All we need to get you booked in is for you to complete the online enrolment form below.

Please give us as much detail as possible, particularly in relation to your medical history, any injuries, aches or pains you might have and your reasons for doing Pilates.  This forms an important part of helping us get you into the right class so please do include anything that might be relevant.

Once you click the submit button we will review your form and get back to you as soon as possible.

ALL INFORMATION WILL BE TREATED IN THE STRICTEST OF CONFIDENCE

Client Enrolment Form

Sex

WHICH COURSE OPTIONS ARE YOU INTERESTED IN?

1. WILL THIS BE THE FIRST TIME THAT YOU HAVE PRACTISED PILATES?

1.1 If NO, have you previously attended:

1.2 If NO, what number of classes did you attend previously:

2. DOES YOUR WORK/SPORT INVOLVE ANY OF THE FOLLOWING?

3. HAS YOUR DOCTOR EVER SAID THAT YOU HAVE ANY SORT OF HEART TROUBLE OR DEFECT?

4. DO YOU FEEL PAIN IN YOUR CHEST WHEN YOU UNDERTAKE PHYSICAL ACTIVITY?

5. ARE YOU, OR COULD YOU BE PREGNANT NOW

6. IF YOU HAVE HAD A BABY/BABIES PLEASE ADVISE WHETHER NATURAL OR C-SECTION AND THE DATE OF BIRTH

7. DO YOU OFTEN GET HEADACHES?

8. DO YOU LOSE YOUR BALANCE BECAUSE OF DIZZINESS OR DO YOU EVER LOSE CONSCIOUSNESS, FEEL FAINT OR DIZZY?

9. HAVE YOU EVER BEEN DIAGNOSED WITH HIGH OR LOW BLOOD PRESSURE OR ARE YOU TAKING ANY FORM OF ANTIHYPERTENSIVE MEDICATION?

10. HAVE YOU HAD MAJOR SURGERY IN THE LAST 10 YEARS?

11. HAVE YOU HAD MINOR SURGERY IN THE LAST TWO YEARS?

12. DO YOU SUFFER FROM ASTHMA, DIABETES OR EPILEPSY?

13. HAVE YOU EVER BEEN TOLD YOU HAVE ARTHRITIC JOINTS OR ANY BONE OR JOINT PROBLEM THAT MAY BE MADE WORSE BY EXERCISING?

14. HAVE YOU EVER BEEN TOLD YOU HAVE OSTEOPOROSIS, OSTEOPENIA?

15. DO YOU SUFFER FROM BACK OR NECK PAIN?

16. DO YOU HAVE PAIN OR RESTRICTED MOVEMENT IN ANY OTHER JOINTS (EG: HIP, KNEE, ANKLE, SHOULDER) OR any movement that causes you pain?

17. HAVE YOU EVER BEEN DIAGNOSED AS HYPERMOBILE (EXCESSIVE JOINT MOBILITY)?

18. IF YOU HAVE ANSWERED ‘YES’ FOR QUESTIONS 12-18, DO YOU HAVE MEDICAL PERMISSION TO EXERCISE?

19. ARE YOU TAKING ANY DRUGS OR MEDICATION WHICH MAY AFFECT YOUR ABILITY TO EXERCISE?

20. HAVE YOU EVER BEEN RECOMMENDED TO TAKE UP PILATES BY A SPECIALIST PRACTITIONER?

20.1 If YES, do you hereby give us permission to contact them?

A. Please advise us before commencing any session if, for any reason, your health or your ability to exercise changes

B. It is inadvisable to do Pilates between weeks 8 to 14 of pregnancy, unless by special arrangement with your teacher. It is also wise to wait six weeks after the birth before resuming exercise.

C. Pilates exercises are very safe but, as with all forms of physical exercise, it is prudent to consult your doctor before starting Pilates sessions.

D. These sessions are not a substitute for medical counselling or treatment. If you have any doubts about the suitability of the exercises, you should refer back to your medical practitioner. The teacher can accept no liability for personal injury related to participation in a session if: • Your doctor has, on health grounds, advised you against such exercise • You fail to observe instructions on safety or technique • Such injury is caused by the negligence of another participant in the class/studio

E. Exercise should be performed at a pace which feels comfortable for you. Pain is the body’s warning system and should not be ignored. Please inform your teacher immediately if you feel any discomfort during a session. Please also inform your teacher if you felt any discomfort after a previous session.

I understand that Body Control Pilates exercises involve hands-on correction and I hereby consent for my teachers to work in this way.

I confirm that I have read and understood the above advice and that the information I have given is correct.

I confirm that my teacher may use the contents of this form, and any other information I may later provide, for teaching purposes, and that this information: • will be used in confidence and stored securely • will not, in any circumstances, be shared with a third party without my written consent, unless that party is another (Body Control) Pilates teacher who will teach me • may be retained by the teacher for a period of time such as complies with professional, legal and insurance requirements that they must fulfill.

I confirm agreement for my teacher to contact me with information on classes and other Pilates-related activities, and understand that I have the right to withdraw this ‘consent to be contacted’ at any time.

Call: 079 6334 0541

 

Suzanne@palacepilates.com