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Personalized Pilates, Inc. Studio

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About
Lessons
Schedule
Teacher Training
Contact

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Name*

First Last

Email*

Mobile Phone*

Home Phone

Work Phone

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Communication:*

Occupation*

Date of Birth*

MM slash DD slash YYYY

Gender*

How did you hear about our Pilates studio?*

Online search

Sign on Shea Blvd.

Referred by Physician or Practitioner

Referred by one of our clients

Personalized Pilates website

Other

What is the other way you heard about our Pilates studio?*

What is your ideal Pilates schedule? (# per week)

What are your best days/times?

Are you hoping to take Pilates classes or private Pilates lessons?*

Private lessons (1-on-1 instruction)

Group classes on the equipment

Combination of privates and classes

Not sure yet

Have you done Pilates before? (Please check all that apply)*

I have never done Pilates before

I have done Pilates on the mat

I have done Pilates on the reformer

I have done chair, tower, & other equipment

I have done private (1-on-1) Pilates lessons

I have done Pilates classes on the equipment

What other forms of movement have you experienced? (Please check all that apply)*

Yoga

Group Exercise

Cardio Machines

Weight Lifting/Personal Training

None of the Above

How important is - Going Down Clothing Sizes?*

Very Important

Somewhat important

Not very important

Not important at all

How important is - Overall Toning?*

Very Important

Somewhat important

Not very important

Not important at all

How important is - Having Fun Exercising?*

Very Important

Somewhat important

Not very important

Not important at all

How important is - Increased Core Strength?*

Very Important

Somewhat important

Not very important

Not important at all

How important is - Increased Flexibility?*

Very Important

Somewhat important

Not very important

Not important at all

How important is - Better Posture?*

Very Important

Somewhat important

Not very important

Not important at all

How important is - Getting Out Of Pain?*

Very Important

Somewhat important

Not very important

Not important at all

Have you ever had a bone scan?*

Yes

No

Do you have Osteoporosis or Osteopenia?*

Osteoporosis

Osteopenia

Neither

Are you currently pregnant or trying to get pregnant?*

No

Yes

Trying to get pregnant

If so, when are you due?

Have you ever given birth?*

No

Yes, all vaginally

Yes, at least one C-section

Have you ever been told you have any of the following conditions? (select all that apply)*

Scoliosis

High/Low blood pressure

Disc bulging or herniation

Arthritis

Stenosis

Diabetes

Spondylolithesis

Joint replacement/fusion

Chronic headaches

None

Other

Are any of these a problem for you? (select all that apply)*

Focused attention for periods of time

Being up high

Being upside down

Auditory cues

Dizziness

Loosing your balance

Manual cues

Complex coordinated movements

Hearing voices in a crowd

None

Other

How active would you say you are?*

Not athletic

Sporadic exerciser

Weekend warrior

Regular exerciser

Professional athlete

How hard would you say you like to workout?*

The idea of exercise is enough

I need lots of breaks

Moderately

I need to sweat

I have been known to vomit while exercising

What goals are you hoping to achieve from Pilates?*

Please list any joints you were unable to use in the last year due to pain:*

Do you have any conditions that currently cause you pain?*

Are you currently on pain meds?*

Yes

No

Δ

We Believe Every Body Deserves To Enjoy Movement!

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Personalized Pilates, Inc.

5010 E. Shea Blvd.
Suite 260
Scottsdale, AZ 85254

(602) 750-5799 text/phone

Lessons

Private Lessons
Group Classes
Teacher Training

Private Lessons
Group Classes
Teacher Training

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Why Us?
Our Team
Contact Us
Privacy Policy
Terms of Use
Blog

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