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Reformation Pilates Intake Form

Health History

Fitness Goals and Preferences

Disclaimer and Signature

I understand that participating in any exercise program involves risks of injury and possible death. I hereby assume full responsibility for any and all injuries, losses and damages that I incur while exercising or participating in any fitness program with my personal trainer. I hereby waive, release and forever discharge my personal trainer, Amy O’Connell, Reformation Pilates, Natural pHilosophy, Inc. and the fitness studio, the landlord, and their respective owners, employees and agents from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in any exercise program or use of any equipment. I understand that my personal trainer is not a medical professional and cannot diagnose, treat or prescribe any medical condition or disease. I agree to consult with my physician before starting any exercise program and to inform my personal trainer of any changes in my health status. I agree to follow the instructions and advice of my personal trainer and to stop exercising immediately if I feel any pain, discomfort or adverse effects. I understand that the results of any exercise program may vary depending on my individual effort, adherence, genetics, nutrition and other factors. I acknowledge that my personal trainer cannot guarantee any specific outcomes or results from the fitness program. I have read, understood and agreed to the above disclaimer and signature.