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Pilates Health Questionnaire

Please fill out the following form to help us understand your physical condition.

Do you have any of the following health conditions: Arthritic joints, bowel or bladder problems, cancer, heart/blood pressure problems, angina, diabetes, low back pain, neurological conditions/seizures, osteoporosis/osteopenia, lung conditions, circulatory conditions, prolapsed/buldging disc in the spine
Do you have any other underlying health conditions/injuries/illnesses, could currently or recently have been pregnant, or are you taking any medications?

Thanks for submitting!

© 2019 by Wallace Practice LTD

Physiotherapy | Muscle Strains | Pilates | Whiplash | Muscle Tears | Sports Injuries | Arthritis | Sciatica | Tennis/Golfer's Elbow | Acupuncture | Tendonitis | Women's Health | Headaches | Podiatry | Chiropody | Spondylosis | Ligament-Strains | Frozen Shoulder | Spinal Disc Injuries | Cartilage Problems | Yoga | Counselling | Incontinence | Pelvic Girdle Pain | Menopause | Repetitive-Strain Injuries | Workplace Assessments | Knee Rehabilitation | Occupational Health | Postural Dysfunction | Neurological Rehabilitation | Foot Pain | Myofascial Pain  |  Low Back Pain  |  Growing Pains   |   Exercise  |  Foot Drop  |  Post Natal  |  Ante Natal  | Electrotherapy | Hip Pain | Sports Massage | Exercise Classes | Pediatric Physiotherapy | Mummy MOT | Specialized Pilates

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