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New client registration formAmy Ford2026-08-21T08:38:20+01:00

Registration Form

General Information

Name *

Address *

Date of Birth *

Sex *

Male Female Would rather not say

Telephone Number *

Email *

How did you hear about Complete Pilates? *

Medical Information

Do you have Private Medical Insurance?

Yes No

Provider

Policy Number

Authorisation Number

GP Name

GP Address

Have you been referred by someone?

Yes No

Are you currently experiencing any pain?

Yes No

Please let us know who

What can we help you with?

Please give us more details

Are you currently on any medication?

Yes No

General Information

Occupation *

Activity levels within the last 2 years (type, frequency, duration) *

Have you previously participated in Pilates? *

Yes No

Please give detail

Medical History

Do you have a history of or are you currently experiencing any of the following: *

No medical concerns Muscle injury Spine injury Recent surgery Glaucoma Hernia High cholesterol High blood pressure Low blood pressure Rheumatoid arthritis Osteoarthritis Osteopenia Osteoporosis Diabetes Asthma Epilepsy Previous cancer Heart conditions Lung disease Recent child birth

Other (please specify)

Females Only

Are you pregnant or have you been pregnant within the last 6 months?

Yes No

How many weeks?

Due Date

Do you have any pregnancy related conditions? (If yes please specify and detail whether you have consulted a Doctor):

Have you ever had a C-Section?

Yes No

Please date

Have you ever received clinical treatment or rehabilitation for a pregnancy related injury?

Yes No

Please specify

Please accept the below policies *

I have read the terms and conditions I understand the cancellation policy I understand the privacy Policy

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Angel Clinic Business Design Centre 52 Upper Street Angel London N1 0QH

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London City Clinic Lower Ground floor 37-39 Lime Street London EC3M 7AY

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Chelsea Clinic First Floor 321 Fulham Road London SW10 9QL

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Norfolk Clinic Unit H Creake Abbey North Creake Fakenham Norfolk NR21 9LF

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© Copyright 2025 - | Designed and Maintained by JID | All Rights Reserved Complete Pilates Medical Ltd registered in England & Wales at 115 Hampstead Road, London, NW1 3EE (for correspondence only), company number: 10206019. Complete Physio Ltd registered in England & Wales. 18 Church Hill, Winchmore Hill, London, N21 2JB (for correspondence only), company number: 05926168

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