Online Assessment

*Please be advised, you will be required to pay R220 for 3 x 45 minute sessions prior to making your booking your classes.

Your name*

Why are you taking Pilates*

Do you have any fitness goals?

Describe your fitness goals*

What are the physical demands of your job? (i.e. sitting, standing, etc.)*

Do you have any current injuries?

Describe your current injuries*

Are you under medical care?

Describe your medical care*

Do you exercise?

How often?

Type of exercise*

Do you have any questions or concerns?

Are you on any medication?

List your medication*

Have you had a history of:

DiabetesYesNo

High blood pressureYesNo

Abdominal surgeryYesNo

Surgery to spine, neck, headYesNo

Shoulder injuryYesNo

Knee injuryYesNo

Ankle injuryYesNo

Wrist injuryYesNo

Low back pain or injuryYesNo

Neck pain or injuryYesNo

FracturesYesNo

OsteoporosisYesNo

Rheumatoid arthritisYesNo

OsteoarthritisYesNo

Are you pregnant?YesNo

If you have said "yes" to any of the above, is it under control?YesNo