BEFORE YOUR FIRST SESSION, I AM GOING TO ASK YOU TO SEND ME THIS QUESTIONNAIRE TO SAVE TIME FROM YOUR FIRST CLASS AND HAVE A BETTER UNDERSTANDING OF YOUR SITUATION FROM THE VERY BEGINNING.

PLEASE ALSO ATTACH ANY MEDICAL INFORM THAT CAN ADD UP AS MUCH INFORMATION AS POSSIBLE.

Fill you Health Questionnaire

THIS HEALTH QUESTIONNAIRE WILL PROVIDE ME WITH AS MUCH INFORMATION TO HAVE A COMPLETE PROFILE BEFORE OUR FIRST SESSION. ALL INFORMATIONGIVEN WILL BE TREATED IN THE STRICTEST CONFIDENCE AND STORED IN ACCORDANCE WITH DATA PROTECTION LEGISLATION.

❊❊❊❊❊ PERSONAL INFORMATION ❊❊❊❊❊ ❊❊❊❊❊

FULL NAME *

First Name

Last Name

DATE OF BIRTH *

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

e-mail address *

Emercency Contact number *

Country

(###)

###

####

HEIGHT (cm) *

WEIGHT (kg) *

❊❊❊❊❊ GOALS & PILATES EXPERIENCE ❊❊❊❊❊ ❊❊❊❊❊

Which aspects would you life to focus more at? *

Core Strenght

Strenght

Flexibility

Stress Management

Posture

Relaxation

Toning

Pain management

Competition preparation

OTHER

Have you done Pilates before? for how long? Where? What kind of Pilates?

Why have you decided to begin your Pilates journey?

Your main objectives, maybe get rid of pain, prepare for competition, loose weight, gain a better posture ...

How did you find the Studio?

A friend, Google Maps, Instagram ...

Hourly availability *

Days and Hour frame (p.e. Mon / Wed from 18h till 21h)

❊❊❊❊❊ YOUR CURRENT HABITS❊❊❊❊❊ ❊❊❊❊❊

The Following questions is for me to have a better understanding of your daily habits, environment and stress factors.

Do you smoke?

What is your occupation? *

Does your occupation involve any repetitive movements or prolonged postures? If YES please explain briefly how is your job environment. *

What other sports and hobbies are you involved with?

Please be as specific as possible. Do you jog outside, you go to the gym, how often, intensity...

Do you have time to prepare your meals?

Do you consider you have a balanced diet according to your personal needs?

Do you get at least 7 hours of sleep every day?

✺✺✺✺✺ DO YOUR SUFFER FROM ANY OF THESE CONDITIONS? ✺✺✺✺✺✺✺✺✺✺✺

PLEASE Detail all the YES answers in the last box in this section. These answers are required to ensure your safety. While Pilates may be practiced safely by most people, certain conditions require special attention. If unsure, please consult your doctor before commencing our sessions.

Abdominal disorder or recent surgery

YES

Back problems

YES

Shoulder or Neck problems / Pain

Specify at the end of this section

yes

Pelvic Floor Issues

yes

Any other Spinal Condition

Specify at the end of this section

yes

Joint Replacement

YES

Any other Joints Condition

Osteoarthritis, HIP condition, Knee, ankle fractures, etc. Specify at the end of this section

yes

Heart Problems

Arritmias / High Blood Pressure / Previos Heart Attacks / etc

yes

High or Low Blood Pressure *

LOW

HIGH

Normal

Epilepsy (Grand Mai Seizures)

yes

Asthma / Lung Conditions

yes

Sensory Disorder or Balance Problems

yes

COVID related symptoms

yes

Diabetes

yes

Depression

yes

Cancer

yes

NEUROLOGICAL conditions like Migrane / Headaches / Disorientation

If yes specify under.

YES

Stroke

yes

Latex Allergy

yes

Oils or Creams Allergies

yes

Are you pregnant?

YES

NOT SURE

I HAD A RECENT ABORTION

DETAIL ALL "YES" ANSWERS HERE. ANY SPECIFICATIONS from the previous questions?

RECENT SURGERIES? Please specify which and datum *

❊❊❊❊❊ NOTES &. CONSENTS ❊❊❊❊❊ ❊❊❊❊❊

VERIFY *

Please, reread all the answers below and check they are correct. Be as specific as possible. IF THERE IS ANYTHING you want to add that you cannot find here, please describe here the ISSUE in the text box.

I CONFIRM MY CONSENT *

By ticking YES, you consent to storing your data for future consultation ONLY FROM MOOW STUDIO to set progress or history updates. "I confirm the above information is correct and that I take responsibility for my health and safety whilst participating in the Pilates / Training Sessions, whether face to face or remotely and I also understand that it is my responsibility to: - Check with my doctor if I have any difficulties or concerns about my ability to participate the sessions. - advise the class instructor ( Elena del Castillo Sánchez) of any change in my medical information or ability to participate in the Pilates session. - Follow the advice given by my doctor and Pilates instructor. No liability will arise on the part of the teacher if I do not follow the instructions carefully or decide to hide any information that will incur further health issues."

YES

Thank You. This means we will meet shortly at my home studio. Stay assured this information will be treated with maximum discretion and professionalism. These answers will give me enough information and save time from your first-time visit.

If you have any medical condition that can be foreseen through medical tests such as Xrays, Magnetic Resonance, Blood tests, or any medical information, please

Please send it to me via email and bring a copy for our first session.

We will have left

A postural assessment to do and to sign a document to accept booking conditions and privacy terms.

Kind Regards & See you soon

Elena