Nobu Pilates Client Intake Form

Lead Name on Booking

Class Time

Class Date

Full Name

Date of Birth

Phone Number

Occupation

Emergency Contact Name

Relationship

Emergency Contact Phone Number

What are your fitness goals?

Have you ever done Mat or Equipment Pilates? If so, which?

Yes (Mat Pilates)

Yes (Equipment Pilates)

How often do you exercise?

Less Than Once a Week

2-3 Times A Week

4+ Times a Week

Please list any previous and/or current injuries:

Do you have any pain or tightness in your body?

Are you pre- or post-natal?

Yes

Have you had any recent surgeries or broken bones?

If yes, please provide further details: