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Home
Instructors
Our Studios
Pilates & You
About Us
History/Instructor Certification
Getting Started
Testimonials
MELT
Schedule • Rates
Rates
Attend a Class
Private Session
Policies
Purchase a Gift Card
News
Contact
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Client Form
Name
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First Name
Last Name
Address
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City
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State
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Zip
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Phone
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Email
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Date of Birth
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Occupation
Do you have experience with Pilates?
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With whom and for how long?
How were you referred to June Hines PIlates?
What are your fitness goals?
Joint Conditions: injuries, broken bones, arthritis, replacements
Surgeries
Respiratory Issues
Heart Issues
Auto-immune Deficiencies
Migraines/Headaches
Diabetes
Varicose Veins
Seizure or other Neurological Disorders
Eye Conditions/Glaucoma
Ear, Nose, Throat Conditions
Thank you!