Health Form

Please complete and submit this health form before you come to your first class. The information you provide will be stored in accordance with Data Protection Legislation and will be treated in strict confidence and will not be shared with a third party without your permission.

Name *
Name
Address *
Address
Landline or mobile number. do not leave any space in the number.
Name and phone number of a local person. Your relationship with this person.
Yoga can be practised safely by most people. However, there are certain conditions which require special consideration in class. Please list health conditions or disorders (neck, shoulders, spine, hips, knees, ankles, heart, blood pressure, back, abdominal, balance, dizziness, asthma/respiration, diabetes, epilepsy, depression). Please also advise if you are pregnant, have given birth in last 6 months or are trying to conceive.
Please state whether you sit, stand, drive and/or use computers for long periods.
Have you done yoga before? If so, for how long and what style? And what are your aims in coming to class?
Declaration *
I understand that there is some risk associated with all forms of movement and exercise. I agree that I take part in the yoga class at my own discretion.
Try not to resist the changes that come your way. Instead let life live through you. And do not worry that your life is turning upside down. How do you know that the side you are used to is better than the one to come?
— Rumi