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Client Intake Form

RISE CLIENT INTAKE FORM

 

 

Name:*
Address:*
E-mail:*
Phone:*
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Birthdate:
Occupation:
Emergency Contact:*
Emergency Contact Phone Number:*
Have you participated in Pilates exercises before?
If yes, for how long?
Do you currently participate in exercise activities?*
If yes, please explain:
What are your goals for your Pilates experience?*
Do you currently have any injuries, pain or soreness?*
If yes, please elaborate:
Are you currently under medical or therapeutic treatment?*
If answered yes, please explain:
Please list any current medications:*