Intake Form

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Company

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Full Name*

First Last

Current Address*

Street Address Address Line 2 City Province Postal Code

Date of Birth*

Email Address*

Enter Email Confirm Email

Phone Number*

Emergency Contact*

First Last

Emergency Contact Phone Number*

Do you have Pilates experience? If yes, please describe.

What are your goals with Pilates?

Are you currently exercising or following any type of fitness program?

What motivated you to reach out now?

Were you referred by a health care professional? If yes, by whom.

Do you have any injuries, conditions or chronic aches and pains? If yes, please describe.

How did you hear about us?

Is there anything else we should know?

Are you interested in private, semi-private or trio group training?

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Waiver to be signed prior to first session

Sign Waiver