Client Screening Form | Nadi Pilates

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Nadi Pilates: Pre-Screening Client Form

First name

Last name

Phone

Birthday

Day

Month

Year

Address

Emergency Contact & Phone Number

Medical & Health History: Please select all conditions that apply to you from below:

Heart condition or chest pain during activity

High or low blood pressure

Dizziness, fainting, or balance issues

Asthma, breathing difficulties

Joint or bone problems (e.g., arthritis, osteoporosis)

Back pain or spinal conditions

Recent surgery (last 12 months)

Pregnancy or postnatal (within 6 months)

Any chronic illnesses or injuries

Are you currently taking medication?

Have you been advised by a doctor not to exercise?

If you answered YES to any of the above, please elaborate here or provide a medical clearance letter if required:

What are your main goals for attending Pilates?

Are you currently exercising? (if yes, describe below)

Yes

Describe what exercise you are currently do:

Have you done Pilates before?

Yes - Reformer

Yes - Mat

Yes - Studio/Clinical

Consent & Disclaimer:

I acknowledge that the information I have provided is true and correct to the best of my knowledge. I understand that Pilates involves physical activity and there is a risk of injury. I agree to notify the instructor of any changes to my health that may affect my participation.

I participate in all sessions at my own risk. If I have any concerns about my ability to safely participate, I will seek medical advice.

Signature

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Date

Day

Month

Year

Get in Touch

Email hello@nadipilates.com

Phone 0451 092 891

Address 179 Mooroondu Road, Thorneside QLD

(by appointment only)

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