07813 332362

Please complete this health screening questionnaire at least 24 hours prior to your first session.

IMPORTANT INFORMATION RE: COVID-19:
If you, or anyone you have been in contact with, has experienced any of the following symptoms in the last 14 days prior to your session:

  • High temperature/Fever
  • Headache
  • Dry continuous Cough
  • Sore Throat
  • Change in/lack of taste and sense of smell

please contact us to reschedule your session for a future date post quarantine guidelines so we can ensure everyone is SAFE.

If you feel unwell or are not sure if you are displaying any of the above symptoms prior to a session at Pilates Gallery. We ask that you call or make contact as soon as possible to cancel your appointment until you are sure you are 100% well. You will not be charged for cancelled sessions due to this reason.

Please note COVID19 precautions:

  • The Pilates Gallery sanitises all equipment used before and after client use.
  • There are hand washing facilities on site with single-use only towels for use before and after your session.
  • There is hand sanitiser available on entry and leaving and we politely ask that clients do not touch door handles or other fixtures if possible.
  • Rooms will be well ventilated with open windows where possible. We will observe the social distancing rule of 1-2m where possible. Posture corrections will be made through verbal coaching and demonstration rather than physical touch.
  • Disposable Masks/face coverings are available and can be requested to be worn by client/ instructor if required.
Name
eMail
Phone
Address Line 1
Address Line 2
Town
Post Code
What is your age? (optional)
Are you on any medication that may affect you during the session?
Have you any illness/disabilities/injuries or joint problems?
Have you been recommended to do Pilates by a health/medical practitioner e.g. Physiotherapist?
Women ONLY: Are you pregnant (or have been) in the last 6 months?
Are there any other conditions that your instructor should be aware of or anything that may affect your ability to exercise?
Briefly, what is your exercise history (i.e. when you last exercised and what activity it was).
What are you hoping to achieve from your class?
If you have answered YES to any of the above questions, we suggest you seek medical approval to continue with your training. Please feel free to mention anything else that I may need to know to keep your session safe both now and as the training progresses. Whilst every effort is made to keep the session both safe and effective there is a risk of injury as with any programme of activity. I am participating of my own free will. On rare occasions, there may be a stand in teacher.

INFORMED CONSENT
By typing my name in the box below, I hereby confirm that I have read, understood and answered honestly the pre-exercise health screening questionnaire.