The Peaks BodyHealth History Form Complete and submit the readiness questionnaire. Takes 3 Minutes. This is your confidential client history form. * First Name Last Name Gender Pronouns * I go by she/her. How about you? Favorite forms of movement. Movement can be a celebration of your body and all that you can do. Think about what your body is accomplishing when you do an activity. Movement should not be used as punishment for anything you are eating. That may take away from the joy. Reason for visit. Stress can take a toll on our bodies. So does working out on auto pilot. We are going to work mindfully toward your goals. Get medical clearance from your physician before starting any exercise training program. Peaks Body LLC reserves the right to deny services to those without their physicians’ written consent/referral. While prescribed medication, I must contact my physician or qualified pharmacist to ensure no risk is involved in starting an exercise program while on this medication. * Yes, I understand. Any allergy or diagnosis you want to inform your trainer about? List medical history. Has your doctor ever said you have a heart condition and that you should only perform physical activity recommended by a doctor? * Yes No Do you feel pain in your chest during physical activity? * Yes No In the past month, have you had chest pain when you were not performing any physical activity? * Yes No Do you lose your balance because of dizziness? * Yes No Do you have a bone or joint problem that could be made worse by a change in your physical activity? * Yes No 1.) If you have answered “Yes” to any of the above, consult your physician before engaging in physical activity. 2.) Tell your physician which questions you answered “Yes” to. 3.) After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. I recently had surgery (in the past three months). Yes No I am preparing to have surgery. Yes No Maybe Please mention what you would like to learn about when it comes to Pilates and movement. * It'll be super helpful to know these things straight from you so I can make classes and videos for exactly what you need <3 Thank You! Now our great work begins.
