New Client

Please complete the following form prior to your first class.

Full Name *

First

Last

Cell Phone *

Email Address *

How would you like to be contacted? *

• Text
• Email
• Phone Call

Are you interested in private one-on-one sessions or semi-private reformer-only classes?

• Private Sessions
• Reformer Classes
• Unsure/No Preference

What days and times would you prefer to attend sessions/classes?

classes? sessions you

Have you done Pilates on Pilates equipment (reformer, trapeze table, etc)? *

• Yes
• No

What are your goals in attending Pilates classes? *

How active are you currently? *

How would you describe your health? *

In general, how do you feel day to day?

Is there any medical history I should know about? *

Are there any movements you can't or should not do? *

Are you allergic or fearful of dogs? (I have two small dogs)

• Yes
• No

How did you hear about Rogue Valley Pilates? *

• From someone I know
• Google Search
• Social Media
• Other

Person who referred you

Submit