Before your first session

New Client Health Questionnaire

Please fill this in at least 24 hours before your Movement Assessment. It lets Teejay spend your hour assessing how you move rather than taking notes. It takes about 10 minutes.

Your answers are confidential. They are emailed only to Teejay and kept securely by The Sogunro Practice. If anything you tell us suggests a different starting point would suit you better, Teejay will contact you before your session.

Booking a Duo Assessment?

Each of you fills in your own form, and answers the two Duo questions near the end. The Duo Assessment suits two people starting out with similar goals. A solo assessment (£85, 60 minutes) is the better start if any of these apply to you:

  • Surgery in the last 12 months, or a joint replacement still in rehab
  • Sciatica or nerve pain with symptoms down the leg or arm
  • A condition still being investigated, or awaiting results or a scan
  • Anything you tick in the important safety questions
  • You would prefer to talk about your history privately

If your answers point to a solo assessment, Teejay will call you before the session. Your booking can be changed to two solo assessments at the standard £85 each, so each of you pays the £15 difference, or cancelled with a full refund.

Full name
Which assessment have you booked?
What brings you in
Medical history: tick any that apply to you now or in the past
Leave blank if none apply. Add a short note on anything you tick in the box below.
Include anything you take regularly, including over-the-counter pain relief. Please mention in particular blood thinners (such as warfarin, apixaban or daily aspirin), steroids, blood pressure medication and any medication for bone density. Write "None" if you take nothing.
Has your GP, consultant or surgeon cleared you to start exercise?
Especially important after surgery.
Important safety questions: tick any that apply to you now
If you tick any of these, please speak to your GP before your session and let Teejay know. Some need urgent medical attention: call 111, or 999 in an emergency. Leave blank if none apply.
Activity and lifestyle
Have you done Pilates before?
How do you learn a new movement best?
Leave blank if you have booked a solo assessment.
Duo Assessment only
Please tick if you have booked a Duo Assessment.
Consent and declaration
• The information I have given is accurate and complete to the best of my knowledge.
• I will tell Teejay about any change in my health before or during my sessions.
• I understand that Applied Pilates and Osteolates Therapy complement medical care and are not a substitute for diagnosis by my GP or a specialist.
• I agree to this information being stored securely by The Sogunro Practice Ltd and used only for my assessment and care.
• I understand that exercise and hands-on treatment carry some physical risk, and I will stop and tell Teejay straight away if anything feels wrong.
• I understand that sessions cancelled with less than 24 hours' notice are charged in full. For a Movement Assessment, the fee is held as credit towards a rebooking.
• I understand that prepaid programmes, courses and blocks must be used within the validity period stated at purchase, and that unused sessions are not refundable.