Pre Class/Workshop Health Questionnaire

Please complete all the questions on this form and press Submit before attending your first class or workshop. Let me know if you have problems or if you’d prefer a paper copy and I can bring one to class for you to complete. 

Providing this information will help in making sure you have a safe practice. In most cases, yoga asanas (postures) can be adapted or excluded to make sure any condition you may have is not aggravated by your practice.

All information will be treated in the strictest confidence. 

Please review our online Privacy Policy if you have any concerns: Privacy Policy

  • Please enter a contact 'phone number - home OR mobile
  • eg 09/11/1994

    I declare to the best of my knowledge that the information given above is correct and I take full responsibility for my own health and well-being during the class. Pressing SUBMIT constitutes an electronic signature.
  • This field is for validation purposes and should be left unchanged.