Pregnancy Yoga Pre-Class Health Questionnaire

Sukhasana_ImageBlueA lot of questions!

However, 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.

Please complete all the questions on this form and press SUBMIT before attending your first pregnancy class or workshop. I’ll have some hard (paper) copies with me in class in case you cannot complete the form on-line.

All information will be treated in the strictest confidence


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    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. I understand that all practices are optional. I hereby waive any and all claims I have now or in the future against Yoga With Arjie and my teacher. I take full responsibility for my body and my baby. If I feel dizziness or pain I shall stop the activity immediately and let my teacher know. If I have any doubts I will seek the advice of a medical professional before proceeding with the pregnancy yoga class. Pressing SUBMIT constitutes an electronic signature.
  • This field is for validation purposes and should be left unchanged.