Name * First Name Last Name Email * Date of birth * MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Emergency Contact * First Name Last Name Emergency Contact Phone * (###) ### #### Are you new to Pilates? If no, please list your experience (mat, reformer, etc) * What are your health and fitness goals? List your current exercise routine: List any and all physical injuries, surgeries, or areas of discomfort/pain: Are you currently pregnant? Yes No Are you currently Postnatal? Yes No Thank you!
