Tone Pilates & BARRE
complete before your first session

physical readiness form
Full Name E-mail Phone Home Address Date of Birth
Are you pregnant?
yes
no
Have you been treated by a physician for any of the following?
heart disease
high blood pressure
gastric reflux
glaucoma
orthopedic/joint (shoulder/elbow/spine/hip/knee)
osteoporosis
arthritis
peripheral neuropathy (numbness/tingling/diminished sensation)
Prior surgeries
Do you carry a list of current medications?
yes
no
Activity Level / exercise frequency Prior movement experience (Dance/Feldenkrais, Yoga, etc.) Emergency Contact name Emergency Phone Submit