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Health Questionnaire & Consent

Hello,

To help ensure your safety and get the most out of your sessions, it’s important for me to know a little more about your health and fitness background. Completing the health questionnaire allows me to tailor the exercises to your needs and ensure any health considerations are accounted for.

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It only takes a few minutes, and your information will be kept confidential. Please complete it as soon as you can – thank you!

Let me know if you have any questions. 😊

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If you already are a member, apologies, I have to ask you to re-complete the form from time to time, to check that everything is still the same and nothing has changed.  It is to keep you safe. 😊

 

Chantal

Health Questionnaire & Consent

Please fill out the following form.

Date of birth
Day
Month
Year
Sex
Female
Male
Prefer not to answer
Other
How did you find Thank U?
Facebook
Instagram
Magazine
Flyer
Google Search
Nextdoor.com
Word of Mouth
Other
Have you done Pilates or Kettlebell before?
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
No
Yes
Do you feel pain in your chest when you do physical activity?
No
Yes
In the past month, have you had chest pain when you were not doing physical activity
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?
No
Yes
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in physical activity?
No
Yes
Is your doctor currently prescribing drugs (for example, water pills for your blood pressure or heart condition)?
No
Yes
Do you have any of the following conditions?

If you have answered no, or have no conditions write NO in the field below.

Do you know of any other reason why you should not do physical activity?
No
Yes

Participation & Responsibility


While Pilates and kettlebell training are generally safe, you should consult your GP before starting any new exercise programme, particularly if you have any existing health concerns.


These sessions are not a substitute for medical advice, diagnosis, or treatment. If you are unsure whether the exercises are suitable for you, please seek guidance from a medical professional.


You are responsible for working at a level that feels appropriate for your body. Pain is a warning sign and should not be ignored. Please stop and inform your instructor immediately if you feel discomfort during or after a session.


By taking part, you acknowledge and accept responsibility for your participation. Thank U Pilates cannot accept liability for any injury where:

  • You have been advised not to exercise by a medical professional

  • You do not follow the instructor’s guidance on safety or technique

  • You exercise with an undisclosed injury or condition

  • You undertake exercises outside of supervised sessions or via online/recorded classes

  • Injury is caused by another participant

  • Injury results from personal inattentiveness


If you have raised any health concerns then do you have medical clearance to exercise? As they say always check with a doctor before exercising?
Yes, I am cleared to exercise

If your answer is No, then pretty please stop completing this form and consult your doctor.

Pregnancy and Postnatal


If you are pregnant, exercise between weeks 8–14 is not recommended unless agreed in advance with your instructor. After giving birth, please wait at least six weeks (or until medically advised) before returning to exercise.

Personal Belongings


All personal items, including vehicles and their contents, are brought to sessions at your own risk. Thank U Pilates cannot accept responsibility for loss or damage.

Hands-On Guidance


Exercise may involve hands-on corrections. By attending, you give consent for your instructor to guide you in this way.


Your Information


You confirm that:

  • The information you have provided is accurate

  • Your details will be stored securely and treated confidentially

  • Your information will not be shared without your consent, unless with another instructor involved in your care

  • Records may be retained as required for legal, professional, and insurance purposes

Staying in Touch


You agree that Thank U Pilates may contact you with updates about classes and related activities. You can withdraw this consent at any time.

I agree to receive updates about my classes from Thank U and subscribe to general correspondence. I understand that I can unsubscribe at any time by sending an email to thankupilates@gmail.com
Yes, I agree!

Photography & Marketing


You can choose whether you’re happy to be included in photos or videos taken during sessions for marketing purposes.


Photos and videos really help small businesses like Thank U Pilates grow and reach more people, so your support truly means a lot.

You can change your preference at any time by emailing thankupilates@gmail.com. Please note, this will not affect any materials already used prior to your request.

Please confirm consent for photos and marketing
Yes, I’m happy to be included
Group shots only (no close-ups)
No, I’d prefer not to be included

Agreement


By participating in sessions, you confirm that you have read, understood, and agree to the above terms.

I confirm that I have read and understood the questions and the information given in this form & that the information I have given is accurate and complete.
Yes, I agree!

If your answer is No, then pretty please go back and read the form again and answer accurately and completely.

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