New Client Questionnaire

Please fill let us know a little bit about yourself so we can address your goals in the intro class.

Have you done any form of Pilates before? YesNo

What type?

Are you pregnant or have recently had a baby? YesNo

Have you had any surgeries? YesNo

Are you currently taking any medications? YesNo

Are you currently involved in a strength training and/or cardio program? YesNo

Has your physician ever said that you have limiting conditions and/or that you should only do physical activity recommended by a physician? YesNo

Do you feel any pain in your chest when you do physical activity? YesNo

In the past month, have you had chest pain when you were not doing physical activity? YesNo

Do you lose your balance because of dizziness or do you ever lose consciousness? YesNo

Do you have any bone or joint problems? YesNo

Do you have any injuries past or present? YesNo

Please describe your current fitness programs:

Please describe your current fitness goals:

What types of classes are you interested in: PrivateDuetsGroup ClassesOther

How did you hear about LifeBalance Studio: Current MemberFacebookWebsiteFriendOther