Client Intake formPlease fill out this form prior to your first session at The Pilates Practice. Contact Info Name * First Name Last Name Email * Phone Number * (###) ### #### Date of Birth * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### Health Information Occupation What are your goals in starting a Pilates practice? Describe any present or past injuries, or significant medical conditions: Are you pregnant? Yes No Do you have any concerns, comments, or requests? Thank you for completing our Intake Form! We look forward to working with you.
