Boutique Pilates Studio
Intake Form
Intake Form Received

Intake Form

Please complete the form below so we can learn more about your goals, match you with the right instructor, and find a schedule that works best for you.

Someone from our team will be in touch within 24 hours.

Prefer to text? Reach us at 917-725-7646.

We look forward to helping you begin or deepen your Pilates practice!

Intake Form

Name(Required)

First Last

Today's Date(Required)

Month

Day

Year

Phone(Required)

Email Address(Required)

What days and times work best for your sessions?(Required)

Please include your preferred days and times, as well as any flexibility in your schedule.

Preference for a male or female instructor(Required)

Female Instructor

Male Instructor

No Preference

Have you had any surgeries?(Required)

Yes

No

When did you have surgery?(Required)

Have you seen a physical therapist in the past five years?(Required)

Yes

No

Please describe your physical therapy(Required)

Is there anything else we should know about your body?

Please share any injuries, physical limitations, or other considerations that may help us tailor your sessions.

What are you hoping to achieve by taking Pilates?(Required)

What is your most important fitness goal?(Required)

Has your doctor recommended Pilates?(Required)

Yes

No

Consent

I consent to the collection and storage of my information for the purpose of processing my submission.

I agree to the privacy policy.