questionnaire BEfore your first class please let me learn a little more about you Name * First Name Last Name What is your occupation? does your occupation involve repetitive movements / activities / postures e.g standing / sitting / bending? Please explain What sports or hobbies are you involved in? If attending pilates for a particular sport (eg. Skiing) please give more specific details of frequency, intensity & desired outcomes. Have you had to discontinue / modify your sports / hobbies? Yes No If yes, please elaborate Are you happy for your instructor to use light touch to adjust your position, posture or exercise technique? yes no Have you done pilates before? yes no are you able to get up & down from the floor independently? yes no Are there any movements that cause you pain? yes no If yes, please give detail Please answer next series of questions honestly & to the best of your knowledge Has your doctor ever said that you have a heart condition & that you should only do physical activity recommended by a doctor? yes no Do you feel pain in your chest when you do physical activity? yes no In the past month, have you had chest pain while you were not doing physical activity? yes no Do you lose your balance because of dizziness or do you ever lose consciousness? yes no Do you have a bone or joint problem that could be made worse by physical activity? yes no Is your doctor currently prescribing drugs for your blood pressure or heart condition? yes no Are you pregnant or had a baby in the last 5 years? yes no Have you had any recent injuries or operations? If yes please give details below yes no Pilates excercises are very safe but, as with all forms of physical exercise, it is prudent to consult your doctor before attending training sessions or starting a new activity. The classes are not a substitute for medical counselling or treatment. If you have any doubts about the suitability of the excercises, you should refer to your medical practitioner. Rotate Pilates & the instructor can accept no liability for personal injury related to participation in a class or private Pilates session if: (a) Your doctor has, on health grounds, advised you against such exercise (b) You fail to observe instructions on safety or technique (c) Such injury is caused by the negligence of another participant in the class Please advise the instructor of your class before commencing class if, for any reason, your situation has changed (this includes pregnancy). please type your name & date below to sign this form. Thank you!