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728 Nostrand Avenue
Brooklyn, NY, 11216
718-484-2295
where movement and wellness meet
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Welcome
Team
Pilates
Group Classes
Private Pilates Sessions
Book Pilates Sessions & Packages
Massage
NEW CLIENT OFFERS
Forms
Pilates Consent Form
Massage Consent Form
Gift OFFERS
Resources
CONSENT FORM
Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact
Phone
(###)
###
####
List any relevant musculoskeletal issues (including any surgeries/C-sections) that could effect your Pilates practice.
List any relevant medications that may impact your Pilates session.
If you are currently in pain or have regular pain, please describe the frequency, type, location, and intensity.
If applicable - are you pregnant or planning a pregnancy?
Yes
No
(If Yes) How many months pregnant?
*Please note* A doctors approval is required for all pregnant clients.
Is there anything else you’d like to share that will help us tailor your practice (goals, other ways you regularly move/exercise, etc.)
How did you find Lula Body?
Strict 24 HOUR Cancelation Policy
CANCELLATIONS MUST BE MADE 24 HOURS prior to ALL appointments. LATE CANCELLATIONS (outside of allowed window) or no-shows will be billed to client's credit card on file. I understand that I am agreeing to these terms via electronic check mark.
I have read and agree to the cancelation policy terms. I understand that I must cancel within the guidelines of my scheduled appointment time to avoid being charged.
Informed Consent: Waiver and Release of Liability
*
I have volunteered to participate in a program of progressive physical exercise and to retain the services of LulaBody to receive physical training. I acknowledge and agree to the following: 1. I am aware that Lula Body will assist me in the Pilates method of conditioning. 2. I recognize that these activities might at times be strenuous. 3. I know that I have the right to choose what exercises I do or do not perform in addition to withdrawing from any exercise at any time. 4. By my participation in any of these activities I present to you that I am physically fit. 5. The muscular and cardiovascular conditioning program at Lula Body utilizes Pilates stretching and strengthening. During and after exercise, there exists a potential for muscle soreness and stiffness, abnormal blood pressure, fainting disorders, irregular heartbeat and instances of heart attack and death. I assume all of the foregoing risks and accept personal responsibility for any other damages or other injury I might suffer. 6. It is my responsibility to ascertain that there is no medical reason to prevent my participation. I acknowledge that if there is any medical reason that may affect my ability to participate in Pilates, I will consult my physician to approve participation. 7. I assume full risk for any injuries I may incur, and waive any claim that I might make against Lula Body. 8. I understand that my email address and mobile number will be used for appointment confirmations, updates and other communications from LulaBody. I have read and understand this informed consent and waiver and release of liability and accurately set forth my intentions and I agree to be bound by its provisions. I understand that I am agreeing to these terms via electronic check mark.
I have read and agree to the terms above.
Thank you!