Before You Start: Health & Movement Form

This helps me understand your body, so sessions feel supportive and tailored to how you respond to movement and load.

This should take about 3–5 minutes.

Your Details

First name

Last name

Email

Phone

Gender

Female

Male

Prefer not to say

Other

Only used where relevant to tailor sessions.

Age

Emergency contact name

Emergency contact phone number

Relationship to you

Your Movement Background

Previous Pilates experience

None

Some mat

Reformer / equipment

Regular practice

Other exercise or activities:

Any exercises you avoid or dislike?

How Your Body Feels Right Now

Are you currently experiencing pain or discomfort?

No

Yes → (enter below)

How does this currently affect you?

Pain qualities (if present)

Other sensations / experiences

What makes it worse?

What helps?

Health & Medical Background

Are you currently under medical supervision for any condition?

Yes

No

Are you taking any medication that may affect exercise?

Yes

No

Are you currently receiving treatment?

Injuries & Conditions

Have you experienced any of the following? (select all that apply)

Common aches & pains

Joint & stability

Spine & discs

Bone health

Osteopenia

Osteoporosis

General / systemic conditions

Other symptoms

Any other diagnosed medical conditions not listed above?

Any past or current injuries, surgeries, or recurring issues that may affect movement?

Mobility & Stability

Do any of the following apply to you?

How Your Body Responds

In movement or exercise, I tend to:

Body response

Push through

Stiff / tight

Unstable / weak

Energy fluctuates

Processing / environment

This helps me tailor how I guide sessions.

After exercise I usually feel:

Energised

Depleted

It varies

I find it easy to switch off and relax:

Yes

No

Sometimes

Hormonal & Pelvic Health (if relevant)

Do any of the following apply?

If relevant, anything you’d like me to be aware of?

What You’d Like Help With

What would you most like help with?