Evaluation

Please fill out the form below.

Do you, or have you ever had any injuries that might stop you from exercising?	Yes No
Have you ever had any back, knee, neck or shoulder pain? Muscular pain? Cramps? Arthritis?	Yes No
Do you have asthma?	Yes No
Do you smoke?	Yes No
Are there any other conditions, which may cause you to modify your exercise program?	Yes No
Have you, or your family, suffered any heart disease? Stroke? Raised cholesterol? Sudden death?	Yes No
Are you on any prescribed medication?	Yes No
Are you pregnant or have you given birth in the last 6 weeks?	Yes No
Do you need DOCTOR'S CLEARANCE?	Yes No
Have you been hospitalised recently?	Yes No
Are you fasting, dieting or on a modified eating plan?	Yes No
Are you participating in any regular exercise?	Yes No
Is there anything, which may affect your ability to undertake an exercise program?	Yes No
Are you over 40-45 and NOT used to regular vigorous exercises?	Yes No
Reason for wanting to learn Pole Dancing or Pole Pilates?
When was the last time you exercised?
On a scale out of 1-10, how important is it that you achieve your goals?
GOALS? What exactly are they?
When do you want to achieve them by?
What results do you want to achieve?	Aerobic fitness? Endurance? Body fat reduction? Sports conditioning? Shape muscle tone? Bodybuilding? Strength training? Stress management? Posture correction? Stretching/flexibility? Rehabilitation?