Pre Class: Health Assessment
Please complete this form to help me assess your personal needs so that more individual help and advice may be given during your class experience. All information will be kept strictly confidential.
Name *
Email *
Telephone Number
Emergency Contact:
Have you done yoga before? YES /NO *
Required
If YES please give details (how long you practised / what style etc.)? *
Do you have any illness, medical condition, disability or anything else you would like to inform me of that may impact on your ability to practice yoga?
Are you taking any medication that may affect your yoga practice? *
Additional Health Information
Declaration: By signing this form you will ensure you work to your body’s ability and if you feel strained or uncomfortable you will let the yoga teacher know immediately so adjustments can be made to avoid injury.
If YES, Sign with Full Name and Date
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