Group Exercise Classes

Your details

1. First Name (required):

2. Surname (required):

3. Date of birth (required):

4. Your Email (required):

5. Your Telephone Number (required):

Fitness to participate

6. Have you been diagnosed with any of the following? (required):

StrokeParkinson’s diseaseMultiple sclerosisBrain injurySpinal cord injuryOther

If 'Other' please add further details:

7. Please select the statement that best describes you. If unsure, choose the closest option (required):

I am comfortable with standing and dynamic movement and can participate in moderate exercise, (e.g., can ascend and descend from the floor)I can manage medium effort movement, may need some support or modifications.I would prefer gentle or chair-based movement due to mobility, balance, or fatigue limitations.

8. How would you rate your typical fatigue levels? (required):

High - need frequent restsModerate – can manage activity with breaksLow – can tolerate sustained activity

9. What exercise classes would you be most interested in? Select all that apply (required):

PilatesChair-based or light conditioning classesMore advanced strength & mobility sessionsBalance & falls preventionFatigue managementCardiovascular/ endurance classesUpper limb strength and conditioningOther

If 'Other' please add further details:

10. Have you ever taken part in a guided exercise class before? (required):

Yes, regularlyYes, a few timesNever

If 'Yes', what guided exercise class was this?

11. What would you hope to improve through this type of program? Select all that apply (required):

StrengthBalanceFlexibilityConfidence in movementManaging stiffness or spasticityPreventing decline or staying activeSocial interactionOther

If 'Other', please add further information:

12. What days would generally work best for you? (Currently weekdays only) Select all that apply (required):

MondayTuesdayWednesdayThursdayFriday

13. What time of day would you prefer? Select all that apply (required):

Morning (9am–12pm)Afternoon (12pm–4pm)Late afternoon (4pm–6pm)

14. Course Length Preferences (required):

4-week course6-week courseShort intensive block i.e., 2-3 sessions per week for a 3-week period

15. What stage are you at in your rehabilitation or health journey? (required):

I’ve recently completed rehab and want to continue progressingI’m in ongoing outpatient therapyI’m managing long-term and want to stay activeI’m focussed on prevention and staying strongOther

If 'Other', please add further information:

16. Would you like us to contact you to discuss the most suitable class for your ability? (required):

YesNo