Initial Consult Form

You are welcome to share as much or as little as feels comfortable. These questions are designed to help me create a supportive and individualised experience.

First name

Last name

Emergency Contact

Contact's Phone Number or Email Address

Do you currently have any injuries, pain, or physical limitations?

Yes

Have you experienced any significant injuries, surgeries, or medical procedures in the past?

Yes

Do you have any diagnosed medical conditions that may impact your movement practice?

Yes

Are you currently pregnant or have you given birth within the last 12 months?

Yes

Are you currently receiving treatment from a health professional?

Yes

How much experience do you have practicing Pilates

None

Beginner

Intermediate

Advanced

What types of movement or exercise do you currently participate in?

How often do you currently move or exercise?

Rarely

1–2 times per week

3–4 times per week

5+ times per week

What would you like to achieve through our work together?

Is there anything you would specifically like support with?

Is there anything that helps you feel more comfortable, supported, or confident when learning and moving?

Do you have any sensory, communication, or learning preferences you would like me to be aware of?

Is there anything you would prefer I avoid during our sessions?

Is there anything else you would like me to know?

Body Autonomy

bodyautonomy.co@gmail.com

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