HabiMat Pilates

Before your first class

Physical activity readiness questionnaire

Please complete the following questionnaire ahead of attendance to your first class. It takes about two minutes, and it helps Holly understand you better and plan modifications where needed. You'll both get a copy as a PDF.

Your details

We'll email your copy here.

Medical history

  1. 1. Have you suffered from heart trouble?
  2. 2. Are you presently taking any form of medication?
  3. 3. Do you suffer from chest pains?
  4. 4. Do you ever have spells of dizziness or feeling faint?
  5. 5. Have you ever had either high or low blood pressure, and/or high cholesterol levels?
  6. 6. Do you suffer from back pain or any orthopaedic problem?
  7. 7. Do you suffer from severe headaches or migraines?
  8. 8. Are you recuperating from a recent illness, operation or injury?
  9. 9. Have you any medical condition that we should be aware of?
  10. 10. Are you pregnant? If yes, how many months?
  11. 11. Is there any history of heart disease in your immediate family (under the age of 55)?

Please note: If you answered YES to any of the above questions, you are advised to seek medical advice/approval before commencing an exercise induction or exercise programme, or consult further with your instructor.

Signature

Sign above with your finger or mouse.

Your answers go to Holly and to you as a PDF, and are kept securely so Holly can check them before class. Only Holly can see them, and she'll delete them whenever you ask.