Parry Pilates - Pilates in Brussels, Belgium

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   > online assessment form
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Please try to complete all the questions that are in the form, so as to provide a class which suits your needs.
If you arent sure about a certain part please enter 'usure' into the box.

1. Personal Information: (* = Required Information)

First Name *	Last Name *
Email Address *	Contact Telephone Number *
Date Of Birth *	Company Name

2. Current Fitness Level:

Please decribe your current weekly fitness activity. Please include any cardio, toning or stretching.

Please describe your most popular daily posture positions.

3. Fitness Goals - Please rate CAREFULLY! - 1 to 5 (1 BEING MOST IMPORTANT)

Lower back correction	Postural correction
Alleviate discomfort	Muscle toning and lengthening
Body shape sculpting	Muscle strengthener
Pelvic stability	Flexibility and range of motion increase
Breath control	Core conditioning
Alleviate neck and shoulder problems

4. Medical Information:

Do you have any current injuries?

Have you had any recent surgeries?

Do you have any Medical Conditions requiring treatment?

Are you taking any medication at present?

5. Please read the following guidelines:

You accept all responsibility for your Pilates Class and informing the teacher of any medical condition you might have.

You confirm that your medical practitioner would agree that you could take part in a Pilates class.

Parry Pilates BVBA & BodyDynamics does not accept any liability for any accident or injury occurring during any Parry Pilates & BodyDynamics class.

I DO accept these guidelines. I DO NOT accept these guidelines.

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