Online Programming Request Form

First name

Last name

Email

Age

Phone

What's your current fitness level?

Beginner (New to Pilates/ Barre)

Intermediate

Advanced

Are you currently pregnant or postpartum?

Pregnant

Postpartum

No

If pregnant, which trimester are you currently in?

First Trimester

Second Trimester

Third Trimester

If postpartum, how many weeks/ months postpartum are you?

What are you interested in?

Online personalized pilates program

Online personalized barre program

Online personalized pre/postnatal program

In person pilates PT

Do you have any injuries/health issues?

Yes

No

If yes, state your health issues.

What are your health/fitness goals?

How often are you looking to train?

1-2 times a week

3-4 times a week

5-6 times a week

Not sure

Anything else you'd like to add or let me know?