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Health Screen & Intake Form

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?
How did you hear about us?

Participation & Acknowledgement

I understand that participation in Pilates and exercise involves some inherent risks, including the possibility of muscle soreness, strain or injury.

I confirm that I am participating voluntarily and will follow the instructions provided by Elongate Pilates and its instructors. I agree to let my instructor know if I experience pain, discomfort or any change in my health that may affect my ability to exercise safely.

I understand that it is my responsibility to provide accurate and relevant information about my health and physical condition and to seek appropriate medical advice where necessary before participating.

By signing this form, I acknowledge these risks and agree to take reasonable care of my own safety while participating in classes.

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