CLIENT INTAKE FORM. Name * First Name Last Name Email * Date of Birth * MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Emergency Contact * First Name Last Name Emergency Contact Phone * (###) ### #### HAVE YOU DONE PILATES BEFORE? IF SO, WHAT ARE YOUR FAVORITE THINGS TO DO? What are your health and fitness goals? * Describe your current exercise routine: List any and all physical injuries, surgeries, or areas of discomfort/pain: * Are you currently pregnant or postnatal? Thank you! We will get back to you shortly!