Your name

Date of birth

Telephone number

Your email

The main reason I would like to join your PilateFix Pilates Classes is to:
  Improve strength and posture  Improve flexibility/mobility  To help me relax  To recover from an injury or painful condition  To prevent pain recurring

I wish to attend the following sessions
  Online via Zoom Monday 2pm (Bronze membership)  Online via Zoom Tuesday 6.30pm (Bronze Membership)  Online via Zoom Thursday 10am (Bronze Membership)  All of the abouve online classes (Silver Membership)  Kent Wellness Hub (in person) Monday 9.30am  One to one Pilates assessment session at BodyMind Solutions Studio

I have practised Pilates before?
  Yes  No

If yes please give some examples (optional)

I heard about BodyMind Solutions "Your PilatesFix" classes from:
  Google  Recommended by a friend  Social Media  Recommended by a therapist or healthcare professional  Already a client of BodyMind Solutions  Other

Please give details of any recent injuries, ongoing painful conditions or any significant medical problems you have/had.

If you are recovering from an injury or have an ongoing painful condition, before you start the class we need to book a call to discuss your rehab plan. Please confirm that you are happy for us to contact you to book a call.
  Yes I am happy for you to book me a call  I do not have any recent injuries or ongoing painful conditions

If female, are you pregnant or have you given birth in the last six months?
  Yes, I am pregnant  Yes, I have given birth in the last six monthsNo

I understand it is my responsibility to advise BodyMind Solutions of any ailment or condition which may affect my participation in a class. I understand that the instructor will advise me regarding appropriate technique for each exercise and all exercises should be practised within a pain free capacity. I accept that it is my responsibility to seek advice from the instructor should I find that an exercise feels uncomfortable for me.
  Yes

I understand that any information I have provided is kept secure and in line with the General Data Protection Regulation and no information will be transferred to third parties without prior consent. Full privacy policy can be viewed at www.bodymind-solutions.co.uk, please ask if you wish to see a written copy.
  Yes