Client Enrollment Form

Please advise me before your session if for any reason you should not perform exercise. The technique of Pilates is very safe, but with all forms of exercise you should consult your doctor before exercising. The sessions are not a substitute for medical counseling or treatment.

If you should have any doubt at all to your ability to exercise you should refer back to your medical doctor. If you are pregnant or undergoing rehabilitation, written medical consent is required.

First Name

Last Name

Date Of Birth

Emergency Contact Person

Email *

Telephone

Address

Do you have any allergies?

Is your blood pressure?

Are you pregnant?

Are you on any chronic medication?

Kindly list medication if applicable.

Do you have children

If yes were your births?

Do you suffer from any backache pain, arthritis, osteoporosis, headaches or joint pain?

Are you seeing a physiotherapist or chiropractor?

Are there any specific movements that cause you pain?

Have you had any operations in the last year?

Past Surgeries

Have you had any major injuries or surgery that I should know about, such as knee or hip replacements, back surgery etc?

Are you doing any other forms of exercise?

How many times per week

What are your long and short term goals with your Pilates training?

Are there any areas of your body that you are specifically wanting to focus on?

Referred by

I accept that Charli Watson should not be held liable for any personal injury whatsoever, of any nature. By my signature I confirm that I have read and accept the terms and conditions of the above.

Check To Accept Terms

Name

Pilates With Charli

I work with all ages, pre/post natal, rehabilitation from an injury or surgery, and with back pain.

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