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Health Screen Form

All students must complete this form before participating in a class.

Date of Birth
Day
Month
Year
Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?
Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?
Do you ever feel faint, dizzy or lose balance during physical activity/exercise?
Have you had an asthma attack REQUIRING IMMEDIATE MEDICAL ATTENTION at any time over the last 12 months?
If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?
Do you have any other conditions that may require special consideration for you to exercise?

IF YOU ANSWERED ‘YES’ to any of the 6 questions, please seek guidance from an appropriate allied health professional or medical practitioner prior to undertaking exercise.

What is your previous experience with REFORMER Pilates?
What is your previous experience with MAT Pilates?
On average, what is the intensity level of your exercise?
Are you pregnant OR given birth within the last 6 weeks?
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