Client Intake Form — FORME by Raven

Personal Information

Basic details and emergency contact information.

First Name *

Last Name *

Email *

Phone *

Date of Birth

How did you hear about FORME?

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship

Health History

This helps me keep you safe and modify exercises when needed. All information is confidential.

Pilates Experience Level *

Never tried it Beginner (< 6 months) Intermediate (6mo–2yr) Advanced (2yr+)

Do you have any current injuries or physical limitations?

Yes No

Have you had any surgeries in the past 2 years?

Yes No

Are you currently pregnant or postpartum within 12 months?

Yes No Prefer not to say

Any medical conditions I should be aware of?

Are you currently under a doctor's care for anything?

Yes No

Your Goals

Help me understand what you're working toward so I can tailor your experience.

What are your primary goals? Select all that apply

How often would you like to practice?

Once a week 2–3x per week 4+ times per week As often as possible

Anything else you'd like me to know?

Waiver + Consent

Please review and acknowledge before submitting your intake form.

I understand that Pilates and movement sessions involve physical activity. I acknowledge that I am voluntarily participating and agree to communicate any discomfort, pain, injury, medical condition, pregnancy, or limitation before and during sessions. I understand FORME by Raven does not provide medical advice and that I should consult a physician if needed before beginning exercise.

I have read and agree to the participation waiver. * I confirm the information provided is accurate to the best of my knowledge. * I do not consent to photos/videos for FORME marketing use.

Full Name Signature *

Date

Tell me about your body.

Personal Information

Health History

Your Goals

Waiver + Consent

Intake submitted.