Pre-Class Form | Loubie Core Pilates

Please complete this form advising of medical issues before booking your first class.

Unfortunately you otherwise will not be able to join class however your booking will still be charged.

First Name

Contact number

Last Name

Do you have a heart condition and not been approved to do physical activity by a doctor?
Do you have either high or low blood pressure? If yes, which type?
Have you ever felt pain in your chest when you do physical exercise?
In the past month, have you had chest pain when you were not doing physical activity?
Do you ever feel faint, lose your balance because of dizziness or have you ever lost consciousnes
Have you ever suffered from unusual shortness of breath at rest or with mild exertion?
Do you have a bone or joint problem that is aggravated or that may be made worse by exercise?
Are you pregnant, is there possibility that you might be, or have you been in the last 6 months?
Are you currently on any prescribed medicines that may affect your ability to exercise?
Do you know of any other reason that may affect your ability to participate in physical activity?

No to all

Yes to some

If yes, please elaborate. If no, please enter n/a

Select a date required

I confirm that the information given in this form is true.

Thanks! see you in class soon!