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Please complete the questionnaire below. This will provide me with the information that I need in order to tailor your Pilates experience. Based on the answers that you give, I may ask you to consult with your doctor before you start. 

All information provided will be treated in the strictest confidence.

1. Has your doctor ever told you that you have a heart condition and that you should only do physical activity as recommended by a doctor?

2. Do you ever feel pain in your chest when you do physical activity?

3. Have you ever had chest pain when you were doing physical activity? 

4. Do you ever feel faint or have spells of dizziness?

5. Do you have a joint problem that could be made worse with exercise?

6. Have you ever been told that you have high blood pressure?

7. Are you currently taking any medication of which the instructor should be made aware? If so what? (Use additional comments box)

8. Are you pregnant or have you had a baby in the last 6 months?

9. Do you experience back pain or have you had any kind of back or shoulder injury in the past?

10. Are there any other reasons why you should not participate in physical activity? If so what? (Use additional comments box)


Talk to your doctor by phone or in person before you start becoming more physically active and before you participate in any classes. Tell your doctor about the questionnaire and which question/s you have answered Yes to.
You may be able to do any activity you want – as long as you start slowly and build up gradually. Or you may need to restrict your activities to those, which are safe for you. Talk with your doctor about the kinds of activity you wish to participate in and follow his/her advice. 


You can be reasonably sure that you can start to become more physically active and take part in a suitable exercise program. Remember to begin slowly and build up gradually.
PLEASE NOTE: If your health changes so that subsequently you answer YES to any of the above questions, you must inform your instructor immediately. Ask whether you should change your level of activity or if you need to be restricted from specific movements. Delay becoming more active if you feel unwell because of a temporary illness such as a cold or flu. Ensure that you inform your instructor at the beginning of a class if you have suffered any recent injury or feel that anything may affect your participation in the class.

Please fill in all fields to submit form.

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