Pre-Joining Form | Loubie Core Pilates

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This short form is a standard health and readiness questionnaire, required for insurance and to help me take good care of you. Many people tick 'yes' to one or more questions — this information helps me understand how best to support you safely and appropriately.

All information is confidential used only to guide your sessions with me.

Thank you for taking the time to complete this important stage in joining us.

First name*

Last name*

Phone*

Please select any that apply to you:

Please respond honestly — selecting relevant points does not mean you can’t take part.

Do you have a heart condition, but not been approved to do exercise by your Dr?

Have you felt chest pain when not exercising in the last month?

Have you ever felt a pain in your chest whilst exercising?

Do you have high blood pressure?

Do you have low blood pressure?

Do you ever feel faint, lost balance from dizziness, or lost conciousness?

Have you ever felt unusual shortness of breath at rest or mild exertion?

Do you have a bone or joint problem that's aggravated by exercise?

Are you, or might you be, or have you been in the last 6 months, pregnant?

Are you currently taking medication that may be affected by exercise?

Do you know of any other reason why your health may be affected negatively by exercise?

If you have answered 'yes' to any of the above, please provide more information here:

I confirm this is an accurate declaration

Signature*

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E-sign or type

Date*

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