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