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Your Name (*)

Your Email *

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Have you attended Pilates classes before?
yesno

Have you any injuries? (Recent or old).
yesno
If yes please describe

Do you suffer from back pain?
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Do you have any other health concerns?
E.g. Asthma, diabetes, high blood pressure, medications etc.
yesno

Are you presently attending a physiotherapist
or another professional regarding treatment?
yesno

Are you presently active in any sports or exercise program?
yesno

Please tick your preferred method of contact:
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