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Questionnaire 

(Your information will remain confidential.)

Have you practiced Pilates before?
If you have done Pilates before please indicate:
Have you practiced Nia before?
Have you experienced massage?

QUICK CHECK CURRENT HEALTH STATUS (tick below any concerns relevant to you)

Tick below any concerns relevant to you:

Where applicable please provide brief explanation:

Section 2:

Massage questionnaire

Fill out this part of the form if you intend to experience our amazing body work practitioners too.

This will serve that you need not fill in an additional form for that when you attend your body work session. 

Possible Contraindications to receiving a massage. To be discussed with your Body worker or Instructor. 

Choose an option applicable to you:

Personal Information – You are the biggest common factor in movement, therapy and healing: movement, massage and body work is an exchange of information between body worker or instructor. Communication optimizes the outcome and helps you and us to fully tune into your body. So beyond this form keep communicating with us during your sessions and remember to let us know if anything new or different arises in your body. 

 

“Each day can be different in our bodies. Lets remain curious on this journey of self discovery, healing and listening.” Jeanne

Muscular skeletal problems
Circulation
Immune system
Digestive problems
Gynaecological
Nervous system

Thanks for submitting!

If you would like to print out the client form please click here to download the new Client Questionnaire

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