Client intake form

Studio: ______________________________

This form helps your instructor get to know you before your first class. It does not replace a medical assessment or diagnosis and gives no medical advice. You can leave any question you are unsure about empty.

1. Personal details

Full name Date of birth Phone Email Emergency contact Emergency contact phone

2. Body and health history

This section is health data. Only fill it in if you give the explicit consent below.

Height (cm) Weight (kg) Ongoing conditions (for example blood pressure, diabetes, asthma) Allergies Regular medication Past surgery or injuries, with approximate dates

Are you pregnant, or have you given birth in the last year?

NoYesPrefer not to say

Has your doctor told you to avoid any movement or exercise?

NoYes, details:

3. Pain and movement

Your pain level over the last week (0 no pain, 10 unbearable)

012345678910

Where do you feel pain or discomfort?

NeckShoulderUpper backLower backHipKneeFoot and ankleOther:

4. Your goals

Why are you starting pilates?

PostureFlexibilityStrength and enduranceLiving more comfortably with painPregnancy or after birthOther:

What would you like to change in the first three months?

5. Privacy notice and consent

Your personal data: The information on this form is processed by [studio name] to plan your classes and keep you safe. Details are in our privacy notice: [where to find the privacy notice or its link].

Health data: The information in sections 2 and 3 is special category personal data under data protection law (KVKK, GDPR). Only the authorised practitioner who runs your classes sees it; the front desk and other staff do not. Consent is optional; if you do not give it, leave those sections empty.

Note for the studio: This is a sample template, not legal or medical advice. Check the privacy notice and consent wording for your situation with a lawyer. Keep completed forms somewhere locked that only the client's practitioner can access. Template: corenta.app/en/templates/intake-form