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Private Pilates Health Assessment

Please fill out the following form
in order to participate in our activity.

First Name

Last Name

Email

Date of Birth

Have you been hospitalized in the last 12 months?

No

Yes

Do you have any current or previous injuries that your instructure should be aware of?

No

Yes

If you answered yes to any question, please provide additional information.

Signature

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Address:

Hours:

Email:

Hilltop:
1402 S 11th Street
Tacoma, WA 98405

South Tacoma:
5411 South Tacoma Way
Tacoma, WA 98409

m-f: 6a - 7p
sat: 7a - 1p
sun: 8a - 1p

Phone:

(253) 878-6761

contact@pplspilates.com

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© 2024 People's Pilates

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