Welcome
Class timetable
About Us
Serap
Alexia
Ashley
Book an appointment with us
Pilates
Yoga
Meditation
Heal Your Life
Hypnotherapy
Reiki
Prices
Testimonials
Blog
Contact Us
Medical Questionnaire
Products
Gallery
Pilates4you Education
Welcome
Class timetable
About Us
Serap
Alexia
Ashley
Book an appointment with us
Pilates
Yoga
Meditation
Heal Your Life
Hypnotherapy
Reiki
Prices
Testimonials
Blog
Contact Us
Medical Questionnaire
Products
Gallery
Pilates4you Education
Physical Activity Readiness Questionnaire (PAR-Q)
Welcome to Pilates4you Studio!
Before starting your sessions with us, we kindly ask you to complete this PAR-Q. This form helps us ensure that your participation in our classes is safe and suited to your health needs.
Personal Information
*
Indicates required field
Name
*
First
Last
Date of Birth
*
E-mail
*
Contact Number
*
Emergency Contact Information
Emergency Contact Name
*
First
Last
Emergency Contact Number
*
Health Questionnaire
Please read carefully the questions below and answer honestly, as you may have to seek guidance from your doctor as to whether Pilates or Yoga is suitable for you.
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
*
Yes
No
2. Do you have high cholesteral?
*
Yes
No
3. Do you suffer from epilepsy?
*
Yes
No
4. Do you have any lung problems?
*
Yes
No
5. Do you have any bone or joint problems, such as issues with your back, knee, or hip?
*
Yes
No
6. Do you have diabetes?
*
Yes
No
8. Do you have arthritis?
*
Yes
No
9. Have you been diagnosed with osteoporosis?
*
Yes
No
10. Do you have his or low blood pressure?
*
Yes
No
11. Is your doctor currently prescribing medication (e.g., water pills for blood pressure or heart condition?
*
Yes
No
12. Do you know of any other reason why should not do physical activity?
*
Yes
No
Additional Questions
1. Are you currently pregnant or have you given birth in the last 12 months?
*
Yes
No
2. Do you have any specific goals or concerns you would like us to be aware of?
*
3. How did you hear about our studio?
*
Friends/ Family
Online Search
Social Media
Other
Agreement and Acceptance
Terms and Conditions, Liability Waiver, Health & Safety Policy, and Cancellation Policy
*
Yes
By ticking the box and signing below, I acknowledge that I have read, understood, and agree to the following:
Terms and Conditions
Liability Waiver
Health and Safety Guidelines
Cancellation Policy
I declare that the information provided here is accurate and complete to the best of my knowledge.
Signature
*
Please type your name as it is equivalent to signature
Date
*
Important Note
: If you answered 'Yes' to any health-related questions, consult your doctor prior to engaging in physical activity with us. This form is not intended to replace or acts medical advice.
Submit