Book your class Before we start, I just need to gather some information from you Step 1 of 6 16% Name First Last House Name / NumberStreetTown / CityCountyPostcodeDaytime number, mobile preferredEmail (personal) Needed for zoom invitationsSexMaleFemaleDate of BirthOccupationSports & Hobbies Emergency Contact DetailsNameContact NumberMobile number is preferred (for text messaging)Email AddressTheir Relationship to you Your background & healthDoes your work/sport involve any of the following? Sitting for long periods Bending Lifting heavy weights Driving Standing Will this be the first time that you have practiced Pilates?YesNoHave you previously attended?: Studio Body Control Pilates Matwork Other Pilates Matwork At home (book/dvd etc) Number of classes attended previously0-55-1010-2020+Has your doctor ever said that you have any sort of heart trouble or defect?YesNoDo you feel pain in your chest when you undertake physical activity?YesNoAre you, or could you be pregnant now?YesNoIf YES when is the due date?Have you been pregnant in the last 6 months?YesNoIf you have had a baby, how was it delivered?NormallyCaesareanNormally with intervention (eg Forceps) More on your health...Do you often get headachesYesNoDo you loose your balance because of dizziness or do you ever lose consciousness, feel faint or dizzy?YesNoIs your blood pressureNormalLowHighHave you had any surgery in the last 2 years?YesNoDo you seer from asthma, diabetes or epilepsy?YesNoHave you ever been told you have arthritic joints, osteoporosis, osteopenia or any bones or joint problem that may be made worse by exercising?YesNoDo you suffer from back or neck pain?YesNoDo you have pain or restricted movement in any other joints?YesNoHave you ever been diagnosed as hypermobile (excessive joint mobility)?YesNoAre there any movements that cause you pain?YesNoAre you taking any drugs or medication which may effect your ability to exercise?YesNoHave you ever been recommended to take up pilates by a specialist practitioner?YesNoIf YES, by yourGPPhysiotherapistChiropractorOsteopathOtherDo you give us permission to contact them?YesNoIf YES, Please provide their detailsPlease list any health problems you suffer and not already mentioned that may affect your ability to exercise Your AimsWhat are your reasons for taking up Pilates?What health or physical goals would you like to achieve over the next three months?What longer-term health or physical goals would you like to achieve over the next 12 months Important informationDisclaimer for online sessions By taking part in an online Pilates class/session, you fully understand that your teacher is not able to offer any personal correction; you agree to take responsibility for your own body; you agree not to perform any exercises or movements that may cause you discomfort; and you confirm that you are fit and able to join the class. You must ensure that you are working in a safe environment and that you are able to clearly see and/or hear your teacher in order to follow instructions. It is your responsibility to let the teacher know before the class if anything affects your ability to exercise that day. By joining the class, you automatically agree to waive all statutory rights against your teacher. Declartion* I agree I confirm that I have read and understood the above advice and that the information I have given is correct This iframe contains the logic required to handle Ajax powered Gravity Forms.