Client Intake Form

Welcome to HeartCore. My goal is for my clients to feel how the Pilates Method can help enhance any activity they enjoy doing outside the studio and leave class feeling taller, happier, energized and calmer.

HeartCore Client Intake Form

Name

First Name

Last Name

Email

Bday

MM

DD

YYYY

Phone

(###)

###

####

Emergency contact name

First Name

Last Name

Emergency contact phone

(###)

###

####

What specific goals do you hope to achieve at HeartCore?

Have you had any injuries, surgeries or other medical treatments?

What activities or sports are you currently practicing?

How did you hear about HeartCore?

Studio Policy

Please read through and check each box to acknowledge your understanding of the information.

HeartCore Studio Policies

Name

First Name

Last Name

Email

Cancellation policy

I understand that if I must cancel a scheduled appointment, I must notify HeartCore at least 24 hours in advance to cancel the appointment or I will be held responsible for payment in full.

I understand

Phones

Please keep your phone on vibrate and store with your belongings for the duration of our session.

I understand

Covid 19

Please provide proof of vaccination.

I understand

Other

Please avoid wearing heavy perfume in the studio.

I understand

Clothing

Please avoid zippers as these damage the equipment.

I understand

Date

MM

DD

YYYY