Skip to content
Contact Us
News
Gift Vouchers
Top Bar
MindBody For IOS
MindBody For Android
Download Our App
Remedy Pilates
Pilates & Physiotherapy
Home
About Us
About Remedy And Our Team
What Our Members Say
FAQs
Pilates
Physiotherapy
Massage
Yoga
Home
About
About Remedy and our Team
What Our Members Say
Frequently Asked Questions
Medical Screening Form
Class Schedule
Pilates
Physiotherapy
Massage
Yoga
Make Appointment
Medical Screening
View Schedule
Make Appointment
Go to Top
Book Now at Remedy
Medical Screening
View Schedule
Medical Screening Form
×
Personal Information
Name
*
Email Address
*
Age
*
Date of Birth
*
Phone
*
Mobile Number
Address
*
City
State/Province
ZIP / Postal Code
How did you hear about Remedy?
*
State two main reasons for attending Remedy
*
Do you have any Covid-19 symptoms?
Fever
Dry Cough
Tiredness
Difficulty Breathing
None
What exercise have you done in the last 6 months if any?
*
Who is your GP?
*
Please tick if you have or had any of the following
*
Chronic or short term illness?
Neurological condition?
Bone or joint disorder - Arthritis/Osteoporosis/other?
Injury to muscles, bones, tendons or ligaments?
Heart problems/High or Low blood pressure/High cholesterol/other
Had or awaiting surgery?
Depression or Mood disorder?
Are you on any medication?
For males and females to answer - How many children/grown up children do you have if any?
For females - Pelvic floor/Gynaecological problems?
For females - How many pregnancies if any?
None
Please give details of all the above ticked or other medical details not above - date of diagnosis/injury/where in your body is the problem/symptoms/how long you have this/how this occurred if known?
*
Please state treatment received for all ticked above and/or treatment obtained for any pain, discomfort or medical issues.
Person to contact in emergency - Please write Name and Contact number.
*
Please note socks with grip underneath the sole are compulsory for your safety while exercising in our premises. We sell these for €20.
*
I have Socks
I need Socks
New Consultation includes an Assessment and a Private Pilates Lesson costing €69.
*
I am aware
IMPORTANT SAFETY PROTOCOLS: Please note we cannot have a waiting area. Please wait in your car or outside until your class or appointment time. It is imperative that you enter at your class or appointment time, NOT before, and exit Remedy 45 minutes later after your appointment or class time. Please wear a face covering to protect you, our staff and other clients. Our staff will be wearing masks/visors. Please bring a small bag with your own hand sanitiser, water bottle, towel and tissues to the studio. Please bring your own Mat for Mat Pilates and Yoga. Minimal personal belongings to be brought into the studio. Please use the sanitising wipes provided to wipe down equipment and Reformers after use. No late arrivals will be accepted. Thank you for understanding and respecting our safety protocols, your health is at the forefront of all our decisions.
*
I understand
Remedy offer online classes to be booked through Mindbody, and that Remedy will send me an email with the Zoom link to join in if I feel the need to exercise at home. Please note you must have the Mindbody and Zoom application to access our online classes.
*
I am aware
I declare to the best of my knowledge the information given here is correct and up to date. I am not aware of any reasons why I should refrain from Physiotherapy, Physical Therapy, Massage, Rehabilitation or Exercise Therapy to include Yoga and Pilates at Remedy, or instructions from Remedy through an online medium. I the undersigned, being aware of my own health and physical condition, and having knowledge that my participation in an exercise or treatment program may be injurious to my health, am voluntarily participating in Remedy's services. Having such knowledge, I hereby acknowledge this release, any Remedy representatives, agents and successors from liability for accidental injury or illness which I may incur as a result of participating in said services. I hereby assume all risks connected therewith and consent to participate in said services. I agree to disclose any physical limitations, disabilities, ailments or impairments which may affect my ability to participate in said services. I hereby consent to assessment, treatment and instruction by the Remedy Team.
*
I Agree
Submit