Name
*
First Name
Last Name
Billing Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email
*
Using the email provided, would you like to receive (occasional - usually twice a year) information about studio news and events?
*
Emergency Contact + Relationship
*
Name and telephone number
I'd love to get to know you better. What professional and personal interests and responsibilities influence your health and movement function? What inspired you to try Pilates with me?
Do you have any activities you want to support through Pilates? (athletic endeavors, arts/music, caregiving, labor)?
Are you recovering from an injury or illness / Challenged by specific limitations or chronic pain?
Have you been treated by a Physician for any of the following?
What types of activities, movements or positions cause discomfort? On the flipside, when do you feel your best?
Back Injury: Specify what area of the spine is affected and check any that apply.
Orthopedic/Joint Problems
Please select all that apply.
Have you had any surgeries or radiation?
Please specify as best you can. It's all relevant to your movement experience!
Physician / PT clearance for Pilates
If you are recovering from an injury or surgery, please specify when your physician or PT cleared you for exercise, and whether they spoke about contraindications.
Do you have any allergies and/or do you carry and medications I should know about?
**If you have severe allergies and carry an Epi Pen, please make sure I know where to find it for you in case of an emergency.
Studio Policy Agreement: Please confirm that you have read, understand, and agree to our 24-hour Cancellation Policy, and Package Refund and Expiration Policy.
*
I have read, agree, and understand that appointments booked with Crescent Trail Pilates, which is a private practice, have a 24-hour Cancellation Policy, and that appointments I've cancelled within 24 hours of my scheduled lesson may be charged in full. Furthermore, I agree to respect the studio's expiration policy for packages of 6 lessons and classes (2 months after first use) and packages of 12 (4 months after first use).
