New Client Confidential FormPlease fill in the below confidential form and submit at least 24hrs prior to our arranged session/event. Name * First Name Last Name Email * Phone * (###) ### #### How would you rate your physical fitness? Great Good Poor What is the reason for your appointment / attendance - what would you like to achieve? * Do you have any conditions with your joints, recent broken bones, injuries or surgery? * Please list any conditions which may impact your session. Please include any current medication for those conditions. * Any other information that might be useful - your occupation / hobbies / sports / pilates or yoga experience please write here; How did you find out about Nic/Inspya Me? * Referred by a friend Social Media Internet Search Other By hitting 'Submit Form' I declare that I have stated all medical conditions that I am aware of and will update Nic Dorsch if any changes occur in the future. I take full responsibility for attending this session / event and will not exceed my limits in the practice of Yoga and Meditation. I declare that I do not know of any reason nor healthcare professional's recommendation to not attend this session. I understand there is a cancellation policy of 24hrs prior notice for appointments and 12hrs prior notice for classes, penalties apply when cancelling with less notice. * I understand Thank you!
