Initial Consultation Questionaire Your details Emergency contact details Any injuries? Are you taking any medications? ---YesNo Have you ever had any undiagnosed pain in any of the following areas (please tick) NeckShouldersBackHipsKneesAnklesOther Are you pregnant? ---YesNo Exercise Intensity ( 1 low - 5 high) ---12345 Frequency (Days per week) ---1234567 Are you, or have you ever trained at an elite level in any sport or art? ---YesNo If yes, please list here Other I agree that the information I have given on this document is true and correct. I have read and understood all the working printed on this document. I take full responsibility for my actions at any and all times on the premises of Aligned for Life Pilates, Melbourne CBD, Richmond and Moonee Ponds. This includes during any workouts, classes, practice and use of equipment whilst engaged in activities on the above premises. I understand that I must give 24hrs notice of cancellation of bookings or a full fee will be charged and that Aligned for Life Pilates has a no refund policy.