New Student Health Intake

Welcome to the studio! Please take a few minutes to share a little about yourself and your body. The more we know, the better we can guide you safely through every class — whether you're stepping onto the mat, the reformer, or the dance floor.

Studio Type & Class Focus

Studio type (e.g. Yoga / Pilates / Dance / Mixed):

Primary class you plan to attend:

Personal Information

Full name:

Date of birth:

Email:

Phone:

Address:

Occupation:

Emergency Contact

Contact name:

Relationship:

Contact phone:

Movement Goals

Physical goals — flexibility, strength, posture, weight, etc.:

Mental and wellbeing goals — stress, focus, confidence, joy:

Target events or milestones — performance, competition, retreat, holiday:

Experience Level

Complete beginner

Occasional practice

Regular practice

Advanced

Years of practice:

Current Health

Please check anything that currently applies to you. Tick all that apply.

Heart condition

High or low blood pressure

Asthma or breathing difficulty

Diabetes

Recent surgery within the past 6 months

Chronic pain

None of the above

Pregnancy / Postpartum

Currently pregnant

Postpartum, less than 6 months

Neither

If pregnant, current trimester:

Injuries & Limitations

Past or present injuries, joint issues, or movements to avoid:

Medications & Supplements

Anything you are currently taking that affects movement, balance, or energy:

Lifestyle

Average sleep hours per night:

Current stress level:

Low

Moderate

High

Prior physical activity — sports, training, or movement history:

Acknowledgement

I have informed my instructor of any health issues listed above

I will listen to my body and rest or modify when needed

I will update the studio if any of these answers change

Thank you for taking the time to share. We're delighted to welcome you into our community — let's move, breathe, and grow together.