New Client History Form

All questions contained in this questionnaire are strictly confidential. Please answer questions honestly and with as much detail as possible. 

DD/MM/YYYY
Name *
Name
Emergency contact name *
Emergency contact name
Medical History
Please be as detailed as possible and include all relevant history including any surgical procedures.
If yes please provide details here.
Females only section
Eg. Cesarean, rectus diastasis, perineal pain, incontinence, back pain.
Lifestyle and Goals
Our Liability *
You acknowledge and agree that CGM Pilates and our Representatives shall not be liable for any injury, illness, accident, loss or damage of any kind whatsoever suffered by you either directly or indirectly in connection with your attendance at or entering the Studio or participation in a Class or as a consequence of my Membership and you release CGM Pilates and its Representatives absolutely from any and all claims in connection therewith. You understand you must give 8hrs notice for cancellations of bookings or the full fee and/or loss of session will apply.