1Personal Information2Exercise and Health Information How did you hear about us? Social Media/Advertisement Google Search Engine Walk In Referral Referral Input* Tell us about yourself so we can set up your account!Full Name* Birthdate* MM slash DD slash YYYY Email Address* Mobile Number*Emergency Contact Person (optional) Mobile NumberPassword* Enter Password Confirm Password Terms and Conditions Label* Check here to indicate that you have read and agreed to the Terms and Conditions so we can ensure the best experience for everyone in Fit to Live! Before we can start your first session, we need to know your experiences, motivations, and healthy history so we can know how to help you best!Exercise Experience:Have you ever done Pilates before?* Yes No Activities do you do?* How often do you exercise?* None 1-2x a week 3-4x a week 5-7x a week What level of intensity do you exercise typically?* Very light Light Moderate Heavy Very Heavy Goals:What would you like to focus on during your workout session? (Check those applicable)* Flexibility Pain Reduction Rehabilitation Stress Management Weight Loss Holistic Wellness Strength Sports Specific Training Anything else input Health History:Please check if you have a history of any of the following:* Neurological Upper Back Issues Head Problems Musculoskeletal Lower Back Issues Neck Pain High/Low Blood Pressure Hip Issues Shoulder Pain Diabetes Knee Issues Elbow Issues Arthritis Ankle Issues Wrist Problems Osteoporosis Foot Issues Others Describe conditions input Have you undergone any surgeries* Yes No If Yes, (Please include dates of surgery or onset, duration, severify & location) Are you taking any medication?* Yes No Please List: Are your Pregnant?* Yes No If Yes, Current Month:
