Health Screening Questions

Welcome to Duo Pilates! To ensure a safe and effective experience tailored to your needs, please take a moment to complete this health screening questionnaire. Your honest answers will help us understand your current health status and any special considerations, allowing us to support you in achieving your wellness goals safely. Thank you for your cooperation!

Health Screen Questions

Please select the pilates class type you are attending...

First Name

Last Name

Emergency Contact Number

Do you currently have any injuries or areas of joint pain we should be aware of?

Yes

Please provide details of your joint pain.

Are there any health conditions we should know about to ensure your safety during sessions?

Yes

Please provide details of your health conditions.

Are you taking any regular medications that may affect your participation?

Yes

Please provide details of your medication(s)

Do you currently take part in any regular exercise or physical activity?

Yes

Please provide details of your exercise routines.

What level of Pilates experience do you currently have?

What would you like to achieve by coming to Pilates? (e.g. strength, flexibility, rehab, relaxation)

How many weeks pregnant are you?

Have you experienced any complications during conception or pregnancy?

Yes

Please give details of any complications during your pregnancy.

Is this your first pregnancy?

Yes

How many weeks post delivery are you?

What type of delivery did you have?

Did you experience any complications in pregnancy, labour or post delivery?

Yes

Please give details of any complications during your pregnancy.

Is this your first baby?

Yes

I confirm that the information I have provided is accurate. I understand this information will be securely stored on file, and will not be shared with any third party.