Intake Form

Title TitleDRMISSMRMRSMS

Name

Email Address

Phone Number

Preferred Contact Method Preferred Contact Method Email Phone

Message

How did you hear about Beau Corps Studio? How did you hear about Beau Corps Studio? Referral Internet Search Newspaper/Journal

What are your exercises goals? What are your exercises goals? Strength/Stamina Weight Management Flexibility balance/spacial awareness Rehabilitation Pain Management Sport Specific Cross-training

Do you have any specific injuries/surgeries that need to be addressed with caution?

What times are you available to work out? What times are you available to work out? 7:00am-3:00pm 3:00pm-8:00pm Saturdays

Have you ever taken a Pilates class on the Pilates apparatus? Have you ever taken a Pilates class on the Pilates apparatus? Yes No

Would you be interested in a complimentary session in a small group setting? Would you be interested in a complimentary session in a small group setting? Yes No