(021) 4636642

appointments@imokillyphysio.com

Unit 2 Market Green Medical Centre

Market Green, Midleton, Co. Cork

Pilates Registration Form









    Health Questionnaire

    Do you have any of the following:





    Pilates participation informed consent.

    The pilates program will begin at a low level and will be advanced in stages depending on your fitness level. We may stop the exercise session because of signs of fatigue or excessive pain. It is important for you to realise that you may stop when you wish because of feelings of fatigue or any other discomfort.

    I understand that with certain conditions a degree of undressing may be required during the assessment, and that the pilates instructor will explain this to me at the time. I understand that the Pilates program will be specifically designed as a personal training plan, and will take into account details given in my health questionnaire and assessment. Therefore, this program of exercise should only be undertaken when in a Pilates class, or when I have been given specific instructions to exercise on my own.

    This information is protected as per the Imokilly Physiotherapy and Sports Injury Clinic Ltd Data Protection Policy.

    I consent that I do not have any COVID-19 symptoms when attending for the initial pilates assessment