Full Name
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First Name
Last Name
Email Address
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Phone Number
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Who can we thank for referring you to Charlotte Blake Pilates?
Please let us know if you'd like to be added to our email list.
Why do you (or why does the person who referred you) feel Pilates might be beneficial for you?
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What injuries, aches, pains, or other physical ailments are you currently healing or dealing with?
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If you're currently pregnant or have ever been pregnant, what changes in your body are you currently healing or dealing with?
(For example: abdominal diastasis, pelvic floor weakness, etc.)
What is your current fitness, physical therapy, or movement routine?
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What is your dream movement routine and desired state of wellness?
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What gets in the way of fulfilling your dream movement routine?
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(Please check all that apply)
What are your top three goals or intentions for your body for the next 6 months?
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Are you interested in virtual or in-person Pilates?
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Would you like to connect with someone on the phone before scheduling a consultation?
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What day(s) are you typically available for Pilates?
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(Please check all that apply)
If there's anything else you'd like us to know, please share it here:
Please note that we collect, process, and store your data according to our Privacy Policy and that submitting this form constitutes your full understanding of and agreement with these terms.
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(You can read our Privacy Policy at www.cbpnyc.com/privacy)
