Pilates, Postnatal and Baby Massage Booking form
Please complete this form if you would like further information or would like to book the postnatal 1-2-1 apt, a baby massage class or baby friendly Pilates class. Please call or text me if you have any questions that you need answered: 087-2115150. Adeline
Where are you based.
Please select where you are based.
FOR BABY FRIENDLY PILATES CLASSES AND BABY MASSAGE CLASSES:
When did your baby arrive i.e. your Baby's Birthday
For normal Pilates classes please date 1/1/19
Which classes are you interested in joining or getting further information about?
Baby Massage in Celbridge usually on Monday @11.30. €100 for 5 two hour classes.
Baby Massage in Celbridge on Tuesday @1.15pm. €100 for 5 two hour classes (runs if other classes are full)
Baby Massage in Maynooth on Wednesdays @10.15/11am. €100 for 5 two hour classes
Baby Massage in Maynooth on Thursday @10.15. €100 for 5 two hour classes
Baby/Child Friendly Beginners Pilates class: €100 for 8 classes (Monday@10.30am or Tuesday@12.30pm) includes 1-2-1. Celbridge only
Adult only Beginners Pilates €100 for 8 classes (Monday@8.30pm or Tuesday@6.15pm) includes 1-2-1. Celbridge only
Repeating Baby Massage or Beginners pilates for free if you have attended both Baby Massage and Beginners Pilates in the same 6 months
BABY MASSAGE CLASSES
Can you let me know why you would like to attend Baby Massage.
Is this your first Baby?
What is your Baby's name?
Has you or your Baby any special needs or is your baby being Medically Monitored?
BABY FRIENDLY PILATES CLASSES
If you are interested in attending a beginners pilates class you need to be off all pain medication and able to go for a walk with baby, You do not need to wait for your 6 week check-up to start. If there is anything I need to know about you, please fill in below. A more detailed assessment form will be forwarded when you book into a class.
If you are enquiring about Pilates classes, have you any previous experience of Pilates or a similar exercise programme, e.g. Class, DVD, teaching, 1-2-1 etc?
Did you encounter any problems doing any of the exercises or did any of the exercises aggravate a pre-existing condition.
2) Are there part of your job that give you pain? e.g. back pain, neck and shoulder tension etc.
3) Current activity level
Where did you hear about the classes?
Someone attending the classes at the moment
Someone who attended the classes in the past
Referral from Physio
Referral from Doctor or midwite
Advertisement in Medical Centre or Pharmacy (main st or tesco shopping centre)
Word of mouth
Referral from another class or group I'm attending e.g. breast feeding group
I attended previous classes
Had been attending the practice for Physio/Hydro
Do Not Fill This Out