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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 *

What exercise have you done in the last 6 months if any? *

Who is your GP? *

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. *

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

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