Pilates Health Questionnaire | Ready for a Stronger, Happier You

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Reformer Pilates • Yoga • Personaltraining • Prenatal + Postpartum

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Congratulations on getting started with Pilates at Eclipse Lifestyle Zug

Before your first session please fill out this form so I can tailor the sessions to meet your needs.

First name*

Last name*

Address*

Email*

Yes, subscribe me to your newsletter.

Phone*

Birthday*

Tag

Monat

Jahr

How did you find out about me?*

Do you have prior experience with Pilates?*

Mat Pilates

Reformer Pilates

Tower Pilates

Chair Pilates

No experience

What are your goals/expectations? What benefits are you looking for?*

Are you recovering from an injury or illness / challenged by specific limitations or chronic pain?*

Are there any movements or activities you're currently avoiding?*

Are you pregnant or have recently giving birth?*

Is there anything else important you would like to tell me?

I sometimes share little class moments on Instagram— would you mind being included in these clips now and then? If you'd like to be tagged, feel free to share your profile name too*

If you’re interested in group classes, would you like to join our community group chat? I share updates, schedule changes, and available spots there.

Yes

How would you prefer to get the invoice?*

Mail

I understand that I participate at my own risk and that Valeria Künzli is not liable for any injuries.

I confirm that the information given is true and complete.

Signature

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If you have supplementary insurance, please fill in the following details for confirmation

Insurance Name

Insurance Typ

Insurance Number