Yoga & Pranayam Class Student              Health Questionnaire
Heath Questionnaire for Students Attending the Essence of Good Health ( Yoga & Pranayam Classes.

To be completed by yoga class participants of the face to face and remote/online classes.

All information provided will be treated in the strictest confidence and stored in accordance with General Data Protection legislation.
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Email *
Full Name *
Date of Birth *
Gender *
Address (Including Post Code) *
Mobile Telephone Number *
Land Line Telephone Number
Emergency Contact Name *
Emergency Contact Telephone *
Emergency Contact Email *
Have you attended yoga classes before?  If so please provide details. *
The following information is required to ensure it is you can practice yoga safely.   Whilst yoga may be practiced safely by most people, there are certain conditions that require special attention. If you are unsure, please consult your GP before commencing class.  Please indicate below whether or not you have any of the following medical conditions and then provide further information (please provide as much detail as possible - especially where a medical condition has been diagnosed/treated by a health care professional): *
If you have selected any of the options above please could you elaborate here.
Please tell us about any surgery you may have had in the past year. *
Do you have any old injuries that still trouble you?       Or any other medical conditions not covered above that might be adversely affected by yoga practice? *
Are you/could you be, pregnant, or have you given birth in the last six weeks? *
Do you participate in any other physical activity, e.g. gym, jogging, swimming, aerobics, cycling, walking or other? *
Please tell us about other physical activities you participate in and How regularly do you do these? *
How did you hear about this class? *
We normally communicate with our class attendees via WhatApp and Signal.  Can we add to the Yoga Class WhatsApp or Signal groups? *
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