Questionnaire

Joining Form

My PAR-Q (Physical Activity Readiness Questionnaire) is a simple but important form designed to help ensure your safety before starting any new exercise or physical activity programme. It asks a small number of health-related questions that identify whether you have any medical conditions, injuries, or symptoms that could affect your ability to exercise safely.

By completing a PAR-Q form, you give fitness professionals the information they need to tailor activities to your individual needs and to recognise when extra guidance or medical clearance may be required. This helps reduce the risk of injury, ensures appropriate support is in place, and allows you to get the most benefit from your training.

Filling in the PAR-Q only takes a few minutes, but it plays a vital role in creating a safe, effective, and personalised experience. Your responses are kept confidential and are used solely to support your health, wellbeing, and confidence as you begin or continue your fitness journey.

● Personal Details

Contact Name *

Address *

Phone Number *

Sex (Male / Female)

Date of birth

Occupation

Sports / Hobbies

● Emergency Contact

Name *

Phone Numbers (please provide more than one if possible) *

● Doctor and Medical

Name and address of surgery

Surgery phone number

Name of Osteopath or Physiotherapist

Other medical consultant?

Have you been cleared by your doctor to exercise? (yes / no)

● Your Goals

What are your reasons for starting Pilates

What are your short term health or physical goals (three months)?

What are your longer term health or physical goals (twelve months)?

● Your Background and Health

Have you ever attended Pilates before, and if so, was it at studio, matwork, or just at home?

If you've taken part in Pilates classes, roughly how many would you say you've done?

Do you have any heart problems or defects? If so, please provide details.

Do you have high-blood pressure? If yes, are you on medication?

Is your blood pressure normal, or low?

Have you had any surgery in the last ten years? If so, please provide information.

Do you suffer from digestive complaints (ulcer, reflux, etc)?

Do you ever lose your balance because of dizziness or feel faint? Yes/ no if yes, please provide details

Have you ever been told you have arthritic joints, osteoporosis, osteopenia or any bone or joint problem that may be made worse by exercising? Yes/ no if yes, please provide details.

Do you suffer from neck or back pain? Yes/ no if yes, please provide details.

Do you suffer with muscle, ligament or tendon problems? Yes/ no if yes, please provide details.

Have you had any ankle sprains or strains? Yes/ no if yes, please provide details

Have you had any bone or stress fractures? Yes/ no if yes, please provide details

Do you have any pain or restricted movement in any joints? (hip, knee, ankle, shoulder) yes/ no if yes, please provide details.

Have you ever been diagnosed as hypermobile ( excessive joint mobility)?

Are there any movements which cause you pain? Yes/ no if yes, please provide details.

Are you - or could you be - pregnant? Yes/ no if yes, how may weeks are you?

Have you been pregnant in the last 6 months? Yes/ no

If you have had a baby, how was it delivered? (natural delivery, caesarean delivery, assisted delivery etc)

Are you taking any drugs or medication that may affect your ability to exercise? Yes/ no if yes, please provide details. ?

Have you been recommended to take up pilates by a specialist practitioner? Yes/ no

Do you hereby give us permission to contact them? Yes/ no if yes, please provide name and contact number/ email address:

Please continue to the next section which contains vital information, signature of understanding, and to submit the form to us.

● Important Information

Please advise your teacher before commencing a class, if for any reason your ability to exercise has changed. It is your responsibility to:

Inform the teacher of any changes that may affect your exercise programme.
Observe instructions on safety or technique on performance or use of equipment
Not to drink alcohol or recreational drugs before a class
Not to have a heavy meal less than two hours before exercise
At all times you must maintain a responsibility for yourself and others in the class

If you have any doubts about the suitability of the exercises please refer back to your Doctor or medical practitioner. The teacher cannot accept liability for personal injury related to participation in a session if:

Your doctor has, on health grounds, advised you against such exercises
You fail to observe instructions on safety or technique
Such injury is caused by the negligence of another participant in the class
You fail to update your Teacher of any changes that may affect your ability to exercise (Client Enrolment Form)

All exercises should be performed at a pace which feels comfortable. Please stop and inform your teacher immediately if you feel any discomfort of pain during a class.

Due to the nature of Pilates, hands on corrections will be made, if you do not feel comfortable with this method, please let your teacher know and an alternative teaching method will be used.

This is a mat based class, if you are unable to get down/ up from the floor please advise your teacher prior to attending the class.

I have full insurance to cover all aspects of teaching whist you are in my studio, however you are not covered by insurance to walk through the garden to the studio so please take care.

I confirm that I have read and understood the above advice and the information that I have given is true and correct. Typing your name as below will be counted as a signature to confim understanding:

Name:

Date: