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Initial Assessment

Initial Assessment Form

Physio & Pilates Clinic

Initial Assessment Form

Date Of Birth
Day
Month
Year

e.g. desk work, lifting, caring, sport

Reason for Attending

What brings you to Physio & Pilates today?

Pain & Symptoms (if applicable)

Do you currently experience pain or discomfort?
Yes
No

Past Injuries & Medical History

Please tick all that apply

Current Health Information

Are you currently under medical care?
Are you taking any medication?
Have you been advised against exercise by a healthcare professional?
Yes
No

Pilates & Movement Experience

Have you practiced Pilates before?
Never
Beginner
Intermediate
Advanced
If yes
How long did you practice Pilates for?
< 6 months
6–12 months
1–3 years
3+ years
Have you ever worked with a Physiotherapist or clinical Pilates teacher before?
Yes
No

Physical Activity & Lifestyle

Current activity level:
Sedentary
Light (walking, gentle exercise)
Moderate (2–3xweek exercise)
High (sports/training)

Personal Goals

What would you most like to achieve through Physio & Pilates?

Ideal Frequency & Commitment

How often would you ideally like to attend sessions?
1x per week
2x per week
3x per week
Fortnightly
Unsure ( Need guidance)
Preferred session type:
1:1 Private
Duet / Semi-private
Small group
Combination of the above
Are you interested in a home or studio-based exercise plan?
Yes
No
Maybe

Anything Else We Should Know?

e.g. fears, previous bad experiences, expectations, pregnancy, hypermobility, time constraints

Consent & Declaration

  • I confirm that the information provided is accurate to the best of my knowledge.

  • I understand that Physio & Pilates involves physical movement and I agree to inform my practitioner of any changes to my health.

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Date
Day
Month
Year

Practitioner Notes (Internal Use)

            •           Postural observations:

            •           Movement assessment:

            •           Key restrictions / precautions:

            •           Initial plan & recommendations:

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