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Yoga Enrolment
Yoga Health Questionnaire
First Name
Last Name
Birthday
Occupation and/ or Hobbies
Do any of these health conditions apply to you?
High blood pressure
Low blood pressure/fainting
Arthritis
Epilepsy
Detached retina/other eye problems
Diabetes
Heart problems
Cancer
Asthma
Recent fractures/sprains
Anxiety
Depression
Recent operations
Back problems
Knee problems
Neck problems
Shoulder problems
Recent pregnancies
Currently pregnant
Do you have any other conditions which are likely to cause you concern when doing Yoga? If Yes, give details:
The decision to perform any form of exercise remains the individual’s and the teacher cannot accept any responsibility for problems during or outside a class. By filling in this form I take full responsibility for my health during the yoga classes, including any injuries. I will inform my yoga teacher of any medical changes that arise. To my knowledge I do not have Covid-19 symptoms and I am not self-isolating. If you find you have any symptoms of Covid-19 please do not attend class. I will abide by social distancing rules and sanitisation rules at the venue. I will bring my own yoga mats while Covid-19 restrictions are in place.
Submit Questionnaire
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