General Agreement Statement and General Health Questionnaire– Carina Flow Yoga
Dear Client!
We have to be able to recognize some of main basic sicknesses, so that YOU as a client get the right treatment, that is why it is necessary for you to fill out this form below about your patient history.
For children who are under the age of 18, a parental guardian has to fill out the form.
Every information that we receive, is dealt with strictly professionally just like any health centers.

1. I have read and understood the rules of the establishment. It is of my knowledge that
any damage that happens to the establishment through my fault and any accidents that may occur of my doing, I am to take full responsibility.
2. I am not to blame any of the establishment workers of the Carina Flow Yoga -
Karina Hubert for any injuries that are of my own doing.
3. We do not have payback guarantee. The already paid for services can not be exchanged for another service. We do not have the means to extend any memberships, they have to be consumed in the given time.
4. According to my knowledge I do not have any illnesses or sicknesses other than
what I have listed in the general health questionnaire. I have truthfully completed this form and I am not concealing any other illnesses.
5. I agree, that the Carina Flow Yoga - Karina Hubert can not and will not forward any
information about my well being and illnesses. The center can not pass on information about my illnesses for any trading purposes.
6. I agree that the Carina Flow Yoga- Karina Hubert should contact me at the address
that I have given.
7. I respect and understand that smoking is prohibited all around the center, this
includes the yard and parking lot as well, if I break these rules I have to pay the fine appointed to me.
8. I understand that if I can not appear at the appointed that I have booked I have to cancel the appointment 24 hours prior the the booked time. If it is not canceled in time I have to pay a 17€ fine.
9. I have made all the decisions without force after all my inquiries has been answered
in a manner that I understood. I agree that I have received all the information that I needed for this agreement, and I have received enough time to think about it.
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Name *
First & Last Name
In case of Emergency Contact (Name and Phone number) *
First & Last Name
Phone Number (optional)
Enter your phone number if you want to receive a text message when we come to your neighborhood.
Adresse e-mail * *
Enter your phone number if you want to receive a text message when we come to your neighborhood.
Please let us know which class you'd love to join! *
Please let us know which language do you speak/prefer. *
Anything else you'd like to share? *
Carina Flow Yoga
Carina Flow Yoga
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