Pilates MN Health History Questionnaire and Release and Liability Waiver

**This form is NOT intended for medical use. If you are a physical therapy patient, please print and fill out our physical therapy forms

Full Name *
Full Name
Address
Address
Phone
Phone
Medical History
Check if you have ever had
Tell us about any injuries, limitations, or symptoms you have had
How did you hear about us? *
Reasons for starting at Pilates MN *
Social and Health Habits
Smoking *
Alcohol *
Exercise *
Clinical tests in the past year *
Release and Liability Waiver
The participant recognizes that participation in a sport, physical exercise, and physical therapy may result in accident or injury and the participant assumed the risk connected with this participation. Participant is in good health and does not suffer from any significant physical impairment, which would compromise their safety of use of Pilates MN's facilities. I understand and voluntarily accept this risk. Participant specifically agrees that Pilates MN, its officers, independent contractors, employees, and agents shall not be liable for any claim, demand, cause of action of any kind whatsoever for, or on account of death, personal injury, property damage or loss of any kind resulting from or related to Participant's use of the facilities or participation in exercise or activity within or without the studio premises, and Participant agrees to hold Pilates MN harmless from same. I authorize Pilates MN physical therapists and trainers the freedom to share medical or physical issues I may have to further benefit my therapy and healing. This authorization may be cancelled by me in writing at any time. I understand Pilates MN's cancellation policy for all privates and classes is 24 hours, however, 48 hours is preferred so that we can fill that space. This policy is industry standard and respects the time, preparation, and schedules or both our trainers and fellow clients. I sign this agreement on my behalf and on behalf of my minor children who may visit the studio.
By checking the box below, I have agreed to all of the terms above *