07980 305 276 info@elizabethnadine.com

1:1 Health Registration Form

Please complete and send this form prior to your a 1:1 session with Elizabeth.

    What would you most like to gain from the 1:1 session(s)? If you have any specific goals or desires, please state them here.

    Have you practised yoga or Pilates before? Please give details of how long, what style of yoga/Pilates etc:

    What do you currently do to keep yourself fit and healthy?

    Physically what would you say your strengths are and your weaknesses?

    Do you have any current, or historic, back or neck issues, injuries or pain?
    YesNo
    If so, please state details:

    Do you have any injuries, illnesses, medical conditions, or disabilities, current or historic, that could potentially impact your workout?
    YesNo
    If so, please state details:

    For those interested in a 1:1 Course, or the 1:1 Transformational Nurture Programme, please read the following statements and tick which most accurately applies to you:

    I do whole body strength training 2-3 times per week:

    I stretch my whole body 2-3 times per week:

    I do at least 30 minutes of moderate cardiovascular exercise 5 times each week or 25 minutes of vigorous exercise at least 3 times per week.

    I eat at least 3 portions of vegetables a day.

    I eat at least 2 portions of whole fruit a day.

    Currently, how would you describe your stress levels.

    I frequently find myself feeling irritable, impatient, or anxious at work or at home, especially when the demands places upon me is high.

    I have difficulty focusing on one thing at a time and I am easily distracted during the day, especially by email, texts, messages, alerts etc on my phone or computer.

    I often find myself thinking negatively (this could be about myself, my work, about others, your partner, or a particular situation etc.).

    I get 7 to 9 hours sleep most nights.

    Are you pregnant or have you had a baby in the past 9 months?

    If yes, please provide further details.

    Do you have any illness, medical condition, or disability?

    If yes, please state details:

    Are you taking any form of medication that may have some bearing on your yoga or Pilates practice?
    YesNo
    If so, please state details:

    If there is anything else you would like to tell me that may help your 1:1 sessions and programme, please do so here.

    Please note that we have a 24 hour cancellation policy as part of our Terms and Conditions.