Health Screening Questionnaire

For Reformer/Pilates/Studio Clients

Welcome to our Reformer Pilates Studio. To ensure your safety and help us tailor your Pilates experience, please complete this confidential health screening questionnaire. The information you provide will remain private and is used solely to assist our instructors in supporting your wellbeing.

First name

Last name

Date of Birth

Year

Month

Day

Phone

Emergency Contact Name & Number

Medical History

Are there any conditions that you need to inform us about prior to taking part in physical activity?

Have you participated in Pilates or reformer previously?

Yes

Consent & Declaration

I confirm that the above information is accurate to the best of my knowledge.
I agree to inform the instructor of any changes to my health or physical condition.
I understand that participation in Pilates involves physical activity and accept responsibility for my own wellbeing.

Signature

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Today's Date:

Year

Month

Day

Health Screening Questionnaire

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