New Students

General Health Questionnaire

Please complete this questionnaire to ensure your safety and inform the class programme. All information given will remain confidential. If there are any changes to your wellbeing, please let me know before class.

Name *

First

Last

Email *

Telephone

D.O.B

Have you practiced yoga previously?

What type of yoga and for how long?

What is your main reason for wanting to practice yoga now?

Any other aspects which interest you?

Please add further details or any information which you feel may be relevant

Do you have any other conditions which affect your mobility or are likely to cause concern during physical activity including mental health conditions?

If Yes, please give details:

If you would prefer not be physically adjusted with touch during practice, please tick

Prefer not

How did you first hear about this class?

Please give contact details in case of emergency: Name/ Relationship to you /Telephone

I take responsibility for my health during yoga classes, including any injuries and I will inform my yoga teacher of any medical changes. *

Please tick to confirm

New Students

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