KDB Energy Wellness Event Questionnaire

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Email *

Name *

What would you like to gain from this session? *

How did you hear about this session? *

Do you have any yoga or breathwork experience? Please don't worry if not - 86% of our students have never set foot in a yoga class before! *

I understand the instructor may be taking photos for training or marketing purposes. Please click your preference below *

Yes

I'd prefer for my face to be blurred out

Please select any conditions that may currently apply to you (check all that apply) *

None

Back Pain

Pelvic Girdle Pain

Symphisis Pubis Disorder (SPD)

Carpal Tunnel Syndrome

Pre-eclampsia

Hyperemisis Gravidarium

High Blood Pressure

Low Blood Pressure

Anxiety or Depression

Diastasis Recti

Required

Emergency contact number in case of an emergency (not required for online participants) *

Is there anything else you would like to make me aware of? *

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