Health Questionnaire

If you are an existing client and have completed our health form within the last 12 months there is no need to complete this form again, but please notify me of any changes to your health.

For new clients, please complete the form on the link below before attending class:

Age group:

Have you done Yoga before?

Which aspects of Yoga most interest you?

If you answered 'Other' above, please specify:

Do any of these health conditions apply to you?
High blood pressureLow blood pressure/faintingArthritisDiabetesEpilepsyHeart problemsAsthmaDespressionDetached retina/other eye problemsRecent fractures/sprainsRecent operationsBack problemsKnee problemsNeck problemsRecent pregnanciesCurrently pregant

If you answered yes to any of the conditions above, please give details:

Do you have any other conditions, which affect your mobility or are likely to cause you concern when doing Yoga?

I take full responsibility for my health during the yoga classes. I will inform my yoga teacher of any medical changes.

I confirm that all information provided above is correct and up to date to the best of my knowledge