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Head shot Chantal straight hair.HEIC

Health Questionnaire & Consent

Hello,

To help ensure your safety and get the most out of your sessions, it’s important for me to know a little more about your health and fitness background. Completing the health questionnaire allows me to tailor the exercises to your needs and ensure any health considerations are accounted for.

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It only takes a few minutes, and your information will be kept confidential. Please complete it as soon as you can – thank you!

Let me know if you have any questions. 😊

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If you already are a member, apologies, I have to ask you to re-complete the form from time to time, to check that everything is still the same and nothing has changed.  It is to keep you safe. 😊

 

Chantal

Health Questionnaire & Consent

Please fill out the following form.

Date of birth
Sex
Female
Male
Prefer not to answer
Other
How did you find Thank U?
Facebook
Instagram
Magazine
Flyer
Google Search
Nextdoor.com
Word of Mouth
Other
Have you done Pilates or Kettlebell before?
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
No
Yes
Do you feel pain in your chest when you do physical activity?
No
Yes
In the past month, have you had chest pain when you were not doing physical activity
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?
No
Yes
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in physical activity?
No
Yes
Is your doctor currently prescribing drugs (for example, water pills for your blood pressure or heart condition)?
No
Yes
Do you have any of the following conditions?

If you have answered no, or have no conditions write NO in the field below.

Do you know of any other reason why you should not do physical activity?
No
Yes
I agree to receive updates about my classes from Thank U and subscribe to general correspondence. I understand that I can unsubscribe at any time by sending an email to thankupilates@gmail.com
Yes, I agree!
If you have raised any health concerns then do you have medical clearance to exercise? As they say always check with a doctor before exercising?
Yes, I am cleared to exercise

If your answer is No, then pretty please stop completing this form and consult your doctor.

I confirm that I have read and understood the questions and the information given in this form & on this webpage (https://www.thankupilates.com/health) under IMPORTANT INFORMATION & that the information I have given is accurate and complete.
Yes, I agree!

If your answer is No, then pretty please go back and read the form again and answer accurately and completely.

Please read the below, and then declare you have read it above and submit your form.

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IMPORTANT INFORMATION

 

Please advise us before commencing any session if, for any reason, your health or your ability to exercise changes.

Pilates exercises and Kettlebell exercises are safe but, as with all forms of physical exercise, it is prudent to consult your doctor before starting any exercise sessions.

It is inadvisable to do exercise between weeks 8 to 14 of pregnancy, unless by special arrangement with your teacher. It is also advised to wait six weeks after the birth before resuming exercise.

These sessions are not a substitute for medical counselling or treatment. If you have any doubts about the suitability of the exercises, you should refer back to your medical practitioner. The teacher can accept no liability for personal injury related to participation in a session if:

- Your doctor has, on health grounds, advised you against such exercise
- You fail to observe instructions on safety or technique
- Such injury is caused by the negligence of another participant in the class/studio

Exercise should be performed at a pace which feels comfortable for you. Pain is the body's warning system and should not be ignored. Please inform your teacher immediately if you feel any discomfort during a session. Please also inform your teacher if you felt any discomfort after a previous session.

 

I agree that Thank U, shall not be liable for injuries I suffer in respect of: *
Exercises I perform during any online class and / or recorded class; exercises I perform outside of a supervised session; exercises performed other than in accordance with the direction / instructions of the qualified instructor; Undertaking exercises while suffering from an injury / ailment of which I have not informed Thank U; Any injury sustained while on the premises resulting from personal inattentiveness


Online and video classes:
By taking part in an online or video class, you fully understand that your teacher is not able to offer personal correction; you agree to take responsibility for your own body; you agree not to perform any exercises or movements that may cause you discomfort; and you confirm that you are fit and able to exercise. You must ensure that you are working in a safe environment and that you are able to clearly see and / or hear your teacher (or video) in order to follow instructions. If you are attending a live class, it is your responsibility to let the teacher know before the class if anything affects your ability to exercise that day. By joining the class live or by following the video you automatically agree to waive all statutory rights against your teacher.

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Please note that no liability is accepted for any loss of or damage to any articles, which you may bring with you to classes. Equally, liability is not accepted for loss of or damage to motor vehicles or their contents and these are left at the owner’s risk.​

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I understand that Body Control Pilates exercises involve hands-on correction and I hereby consent for my teachers to work in this way.

I confirm that I have read and understood the above advice and that the information I have given is correct.

I confirm that my teacher may use the contents of this form, and any other information I may later provide, for teaching purposes, and that this information:

• will be used in confidence and stored securely
• will not, in any circumstances, be shared with a third party without my written consent, unless that party is another teacher who will teach me.
• may be retained by the teacher for a period of time such as complies with professional, legal and insurance requirements that they must fulfil

I confirm agreement for my teacher to contact me with information on classes and other exercise-related activities, and understand that I have the right to withdraw this ‘consent to be contacted’ at any time.

 

I grant permission and give consent for  the use of photos and electrical images from the sessions to be used for marketing purposes.  I can revoke permission at any time by sending email to thankupilates@gmail.com * The revocation will not affect any actions taken before the receipt of the written notification.

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