Health Check Form & Privacy Notice
Section 1: General Contact Details
Section 2: Lifstyle & Medical History
Do you take part in regular physical exercise?*
Do you have any current health problems?*
Do you suffer from a disability?*
Have you had surgery in the last 6 months? If yes, please give details below:*
Are you pregnant or had a baby in the last 6 months? If yes, please give details below:*
Do you suffer with a prolapse. If yes, please give details below:*
Do you have pain or limited movement in any joints? If yes, please give details below:*
Section 3: General illness issues
Asthma or shortness of breath
The above health responses given are reflective of my current status. I agree to inform Liz Dolman, Instructor, Love Pilates, if there are any changes in my health status due to injury, illness or otherwise. I will consult with my doctor and not partake in the class until I have been advised by my doctor, that it is safe for me to do so. I acknowledge that there are inherent risks in taking physical exercise and that I know of no medical reason why I should not undertake a Pilates/Fitness exercise program.
I also agree to comply with any verbal instructions from the instructor regarding health and safety whilst doing the class online /or face to face.
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By signing below, you explicitly consent to us processing the personal data you have included in this form in accordance with our Privacy Policy that is set out on our website for the purposes of us providing the services and as otherwise set out in our Privacy Policy.
We may from time to time send you details of our goods or services that we feel may interest you, such extra sessions, workshops, events and equipment that may be on offer by email or via electronic messages. If you would NOT like to receive such offers, please tick below:
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