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Your Name (*)

Your Email *

Your Phone

Have you attended Pilates classes before?
 yes no

Have you any injuries? (Recent or old).
 yes no
If yes please describe

Do you suffer from back pain?
 Yes No

Do you have any other health concerns?
E.g. Asthma, diabetes, high blood pressure, medications etc.
 yes no

Are you presently attending a physiotherapist
or another professional regarding treatment?
 yes no

Are you presently active in any sports or exercise program?
 yes no

Please tick your preferred method of contact:
email post phone 

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