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Reform Pilates
Health Questionaire

First Name

Last Name

Email

Date of Birth

Do you have a doctor's permit to particiate in intense physical activities?

No

Yes

Have you lost your consciousness in the last past 12 months?

No

Yes

Initials

Select a date

Have you had Covid -19 at any point since the pandemic broke out?

No

Yes

I declare that the info I've provided is accurate & complete

Thanks for submitting!

Our Venues:

THE OLD HOP KILN
1 Long Garden Walk

Farnham
GU9 7HX

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