Before starting with any LIVe service, please complete the following information. Your medical information is an important part of making sure we can meet your needs and provide the best instruction for you to gain maximum benefit. The information you provide is confidential and used only for LIVe processes according to our privacy statement..

* First Name:
* Last Name:
* Your Email Address:
* Phone:
Have you ever suffered from any of the following medical conditions?:	Diabetes. Stress or High Blood Pressure. Asthma or Respiratory Illness. Heart or Chest Pains. Epilepsy, Fainting or Dizziness. Arthritis. Neck Pain Back Pain. Any other muscle or joint pain.
Please give details if you answered yes to any of the above:
Are you pregnant?:	Yes No N/A
Have you had a baby in the last 6 months?:	Yes No N/A
* Has a health professional ever advised you against any form of exercise? :	Yes No
If yes, please explain:
Are you aware of any injury, past or present, which may be aggravated by any form of exercise?:
* How do you perceive your current level of fitness?:	Low Average Good High.
Reason for attending pilates?:
* How did you hear about LIVe?:	-- Please choose an option --Google adwebsiteflyerfriendother
I have read and agree to the Terms and Conditions
Terms and Conditions I hereby release Live Pilates, including all employees and all locations in which Live Pilates operates, from any responsibility or liability due to my participation in services of this company. I am fully aware that I am participating in these sessions at my own risk and will not hold Live Pilates responsible in the event of myself incurring any injury or exacerbating any previous conditions I may have. I fully intend to use common sense when practising Pilates and will be mindful of my own physical limitations and prior injuries so as not to sustain further damage. If I have any comprehensive medical conditions, I have consulted my physician to ensure Pilates is an appropriate exercise for me to participate in.
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