My Local Pilates - Classes and courses in Hackney, Homerton, Hackney Wick, Clapton
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Client Enrolment Form
Healthy Back

All information will be treated in the strictest of confidence

    Personal Details

    dd/mm/yy

    Emergency Contact


    Your GP


    PART 1: General Medical Information

    Do you suffer from any of the following? If yes, please give details where requested:












    Part 2: Pregnancy




    Part 3: Background Information








    Part 4: About Your Back


    Part 5: Important Information

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

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


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

    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 warming system and should NOT BE IGNORED. Please inform your teacher immediately if you feel any discomfort during a session. Please also inform the teacher if you felt any discomfort after a previous session.

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