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CLIENT INTAKE FORMS
Refund Policies/Terms & Conditions
Contact Details
First name
*
Last name
*
Email
*
Best Phone Number To Reach You
*
Emergency Contact Name & Phone Number
*
Best Method To Reach You
Phone
Text
Email
Multi-line address
Country/Region
Address
City
Zip / Postal code
Birthday
Month
Month
Day
Year
Submit
Download, Print and Sign
Brava Pilates Liability Waiver pdf
If you prefer, and/or you don't have access to a printer, you may fill and sign this form when we meet for your first session.
Current Health & Fitness Goals
Name
*
What level of intensity are your current workouts?
Very Light
Light
Moderate
Heavy/Mixed
What do you feel your current condition is?
*
What Would You Like To Focus on in your Sessions?
Flexibility
Endurance
Strength
Weight Loss
Rehabilitation
Sports Conditioning
Stress Management
Pain Reduction
What Else Would You Like Me To Know About Your Goals?
Are you under any Medical Restrictions?
Are you pregnant?
Yes
No
Do you take any Medications? Please list types & purpose.
Do you currently have or have you had a history of any of the following?
Lower Back Issues
Upper Back Issues
Neck Problems
Disc Issues
Scoliosis
Sciatica
Hip/Knee/Ankle Issues
Shoulder Issues and/or Dislocations
Leg Length Difference
Tendon/Muscle/Ligament Issues
Arthritis
Joint Replacement
Osteoporosis
Headaches
Neurological Conditions
Numbness/Tingling
Vertigo/Dizziness
High/Low Blood Pressure
Heart Disorder
Seizures
Diabetes
Cancer
Abdominal Surgery
If so, Please List Onset/Duration/Severity/Location...& Any Other Concerns/Issues not listed?
Submit
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