San Luis Obispo Pilates Studio
 
Equipment Classes | Mat Classes | Prenatal Classes | Post Pregnancy Classes | Lymphatic Drainage Therapy | Massage Therapy | Skin Care | Holistic Nutrition

Client Information
Name:
Address:
Employer:
Employer Address:
Phone Number(s):
Email:
Emergency Contact Name, Number & Relationship:
Physician name & phone number:
Would you like to receive information on classes and discounts by email? yes no
Read carefully and answer as it applies to you.
Do you have a heart condition? yes no
Do you ever have chest pain(s), shortness of breath or heart palpitations? yes no
Are you ever dizzy or lightheaded? yes no
Do you have high blood pressure? yes no
Do you have a joint, bone or connective tissue disorder? yes no
Do you have any back and or neck problems? yes no
Have you ever had any type of orthopedic surgery? yes no
Are there any physical/psychological reason(s) why you should not participate in a Pilates exercise program? yes no
Are you accustomed to physical exercise? yes no
Are there any physical/psychological condition(s) you feel that I should be aware of? yes no
If so, please list.
Do you have any specific injuries that should be discussed? yes no
If so, please list.
Are there any areas of you body that you would like to address specifically? yes no
If so, please list.
Have you recently had an annual physical examination by your doctor? yes no
If so, Please list.
Date of last physical:
All classes are prepaid. There is a 24 hour cancellation policy. Please notify the studio within this 24 hour period if you wish to avoid being charged for missed classes.
 
"Everybody can have a Pilates body!"
Equipment Classes | Mat Classes | Prenatal Classes | Post Pregnancy Classes |
copyright 2007-2009 San Luis Obispo Pilates Studio