New Client Form

In order for you to have the best experience possible, please fill out this form so we can know a little more about how to tailor your Pilates experience. Can’t wait to practice with you!

Name

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Have you practiced Pilates in the past? If so, how long and what type?

How would like to grow/improve in your individual practice of Pilates?

How many classes per week would you like to commit to practicing Pilates?

Have you been hospitalized in the last 12 months?

Yes

Are you currently suffering from a medical condition, illness, or injury?

Yes

If you answered YES to any of the questions above, please elaborate below:

I declare that the info I’ve provided is accurate and complete. I certify that my participation in Practicing Pilates w/ Karen is a potentially hazardous activity. I have been informed of and am aware that any exercise and /or fitness activities involve a risk of injury, and that I am voluntarily participating in these activities with understanding of the risks involved. I hereby agree to assume and accept any and all risks of injury regardless of severity. I understand that all information and services provided by Practicing Pilates w/ Karen are of a general nature and are provided for educational purposes only. None of the information or services provided are to be taken as medical or other health advice pertaining to any specific health or medical condition that I have or may have had. The information and services provided by Practicing Pilates w/ Karen are not a diagnosis, treatment plan, or recommendation for a particular course of action regarding my health and are not intended to provide specific medical advice.