Health Questionnaire

To help me to help you get the most from this class, please complete the following short questionnaire. The information will be used to make the time we spend together as fruitful as possible, enabling me to tailor the class to suit your individual needs but also the need of the group and to ensure that you exercise safely.

Any information you give will be treated in the strictest confidence and will not be shown to anyone else.

Some little tips to get the most out of your class:

  • Try not to have a big meal two hours prior to class
  • Wear loose, comfortable clothes
  • Drink plenty of water before, during and after class
  • Bring with you a sense of humour, love and joy
  • Most of all have fun and smile, this is your time!

Age group
Under 1617-3435-4445-6465+

Are you currently taking medication?
YesNo

Do any of these health conditions apply to you?
High/Low Blood PressureEpilepsyAsthmaHeart ProblemsDepressionIBSOsteoporosisJoint ProblemsSpine IssuesRecent PregnancyMigraineRecent Fracture/SprainArthritisBack ProblemsDiabetesNeck ProblemsHerniaEye ProblemsKnee Problems

What would you like from your yoga class?
RelaxationBreath WorkWeight LossStress ReliefMeditationBody AwarenessAid InsomniaAid FatigueStrength & FlexibilityBetter PostureMental/Emotional WellbeingBecome more balanced

Would you be interested in any of the following?
1 Day WorkshopsWeekend Retreats1-2-1 Yoga