Circle Studio: Pilates Reformer Intake Form & Assessment

Please complete this form before your first Pilates Class.

Personal Information:

First name

Last name

Email

Phone

Age

Birthday

Year

Month

Day

Emergency Contact

Emergency Contact Phone

Health History

Do you have any medical conditions, injuries, or physical limitations?

If yes, please describe:

Current Fitness Level & Goals

How often do you exercise per week?

If "Other" please list this below

Experience with Pilates & Reformer Equipment

If "Other" please list this below

Are your currently (check those that apply)

If "Other" please explain below

Acknowledgment & Signature

I acknowledge that I have provided accurate information and understand the potential risks associated with Reformer Pilates. I will inform my instructor of any changes in my health status.

Date

Year

Month

Day

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Yes, subscribe me to your newsletter.

Join Our Mailing List!

Circle Studio: Pilates Reformer Intake Form & Assessment

Join Our Mailing List!

Join our mailing list