Medical Questionnaire

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Your Name (required)

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Any medical details to be aware of

If you answer ʻyesʼ to any of the following questions please give details above.

Has a doctor ever said you have heart disease, high blood pressure or any other cardiovascular problems?

Is there a history of heart disease in your family?

Do you suffer from, or have a family history of, arthritis?

Do you suffer from, or have a family history of, osteoporosis?

Do you suffer from any allergies or asthma?

If so, do you use an inhaler or take antihistamines?

Do you often feel faint or dizzy and if so is it made worse by exercise?

Are you or have you recently been pregnant?

Have you ever had either abdominal or joint related surgery?

Are you taking any drugs/medication at the moment or are you recuperating from a recent illness or operation?

Do you have any other medical condition that may affect your ability to exercise?

Do you suffer from pain or limited movement in any joints?

Have you ever had an injury that has required musculo-skeletal therapy (e.g. Physiotherapy)?

Are you currently under the care of a manipulative or physical therapist (Chiropractor, Osteopath, Physiotherapist etc.)?

If you answered yes to the above question, have you told them that you are attending the participating in Pilates?

I have answered these questions to the best of my belief and know of no other reason why I should not undertake a course of exercise. I will inform my you if my medical condition changes in the future.