Health Screening Form

General Details
Doctor details
Emergency Contact
Aims & Goals

Please select as many as you feel appropriate


Please select all that apply

Medical History

If you are currently attending a physiotherapist / osteopath / chiropractor for any kind of treatment, please specify the name of your physiotherapist / osteopath / chiropractor and the name of their practice. With your permission, we would prefer to make contact with them prior to you commencing classes / one-to-one sessions:

Client Release Statement

I understand the above questions and I have answered to the best of my knowledge. I agree that I am in good physical condition (except as stated above) and accept that I exercise at my own risk. I understand that whilst the utmost of care is taken, that neither individual instructors, InspireFit or KM Pilates will be liable for any damage or injury.

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All information given is strictly confidential

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