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Physical Activity Readiness Questionnaire:

Please complete the following form before participating in a class.

All information provided will be treated in the strictest confidence.

Personal Details

Medical History

Have you had any operations in the last 12 months?
Do you have a history of heart problems or chest pain when exercising?
Do you have any joint problems or back complaint?
Are you currently pregnant or have you given birth in the last 6 months?
Do you have breathing difficulties or asthma?
Do you have high or low blood pressure?
Do you take any regular medication?
Are there any other medical conditions, injuries or illnesses that you suffer from?

By taking part in a Discover Pilates class or online programming, you agree that you are fit and well and there is no reason to the best of your knowledge as to why you should not participate. If for any reason your health or ability to exercise changes from the information you have given you agree to update this with Emma Smale. It is recommended to consult with your doctor before participating in any new exercise regime. If you have answered ‘yes’ to any of the Physical Activity Readiness Questions, you agree that you have obtained your doctors permission and have been medically cleared to participate in an exercise class. By agreeing to the terms and conditions, you agree and understand that you are taking part in a Discover Pilates class with Emma Smale at your own risk and fully release from liability and waive legal claims against her for any injury or damage that you may incur during participate.

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