Body Pilates
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Home
About
Classes
Trainer
Body Pilates
Pilates Classes in Essex
Join
Join
If you are interested in taking Pilates classes with Nicola at Body Pilates, then please fill in the form below and Nicola will get back to you as soon as she can.
Name
*
First Name
Last Name
Email Address
*
Phone Number
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date Of Birth
MM
DD
YYYY
Waiver
I have signed and submitted the waiver via this site.
I will sign the waiver on-site.
Occupation
Sports/Hobbies
Work
Does your work/sport involve any of the following:
Sitting for long periods
Bending
Lifting heavy weights
Driving
Standing
Any other repetitive action
Medical
Has your doctor ever said that you have any sort of heart trouble or defect ?
Have you ever been told that you have arthritic joints or any bone or joint problem that may be made worst by exercise?
Are you pregnant, or have you had a baby in the last year ? If yes please give details below in the further information box
Have you had any operations or injuries in the last year?
Do you suffer from backache?
Blood Pressure
Low
Normal
High
Physical exercise
Is there any other good reason not yet mentioned that should stop you performing physical exercise ? If so please mention it
Movements
Are there any movements that cause you pain ? (e.g. raising your arms, bending forward or to the side, etc)
Remedial exercises
Have you ever been given any remedial exercises? If so, can you briefly describe them.
Specialist practitioner
Have you ever been referred by a specialist practitioner?
No
Yes
Practitioner name
If yes, please state their name and contact No
Goals
What do you want to achieve from your Pilates session?
Class
When would you like to take your Pilates class?
Monday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thank you!