Have you had any operations or injuries in the last 12 months?
If so, what was your operation or injury? Add N/A if none.
Do you have any of the following?
Do you have any previous injuries, conditions, or surgeries we should take into account? Please provide approximate dates of surgery.
Do you experience any pain?
If yes, please tell is where the pain is. Add N/A if NO is selected above.
If yes, how frequent is the pain?
If yes, how painful is the experience.
Roughly how long have you had this problem?
Do you have any pins and needles, tingling, numbness or weakness associated with this pain?
What positions/movements/activities make the problem worse?
What positions/movements/activities make the problem easier?
Have you seen a physio, GP or other medical professional about your current condition recently or in the past? (If so please provide details)
Have you participated in Reformer or Mat Pilates before?
Are you pregnant or have you had a baby in the last 12 months? If so, please provide Date of Birth or Expected Date of Birth. *
Do you require any special arrangements? Do you have any other condition, disability, or issue that we should know about to ensure you have a comfortable and positive experience at Balanced?
Name of next of kin — in case of emergency.
Emergency contact number.
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