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Home Memberships

Book

Pilates

In-studio Pilates Classes Private Pilates Session

Physiotherapy

Physiotherapy Appointments Menopause MOT Mummy MOT - Postnatal Check Up Appointments

Massage

Massage Appointments

Shop

Treatment Packages Pilates Equipment Gift Vouchers My Orders

Videos About Us Login

£55 / month

Core Plus Membership

Core Plus Membership

First Name *

Last Name *

Phone *

Email *

Date of birth *

Emergency Contact Form

Emergency contact name: *

Emergency contact phone number: *

Emergency contact relationship: *

General Health

How would you rate your general health 1-5 (1= bad, 5= excellent) *

1
2
3
4
5
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Health questionnaire: are you experiencing / in the past have you experienced any of the following conditions? *

Lower back or pelvic pain

Any other spinal condition

Recent injuries or surgeries

Osteoarthritis

Osteoporosis

Any heart conditions

Diabetes

Rheumatoid arthritis

Stroke

COPD

Epilepsy

Asthma

Any allergies (medication, food & latex)

High or low blood pressure

Cancer

Depression, anxiety, or mental health diagnosis

Thyroid problem

Incontinence, prolapse or pelvic health issues

None of the above

Were you recommended Pilates by a healthcare professional (GP, physio, osteopath, etc)? *

Yes
No
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If you marked any of the above conditions, or have anything else significant in your medical history, please give further details below (condition, when diagnosed, treatment undertaken, if it affects you when you exercise). (If not applicable write 'N/A'):

Do you take any regular medication? If so please list:

Are You Pregnant? *