Health Questionnaire

To help us to help you get the most from your sessions, please complete the following short questionnaire. The information will be used to make the time we spend together as fruitful as possible, enabling us to tailor the sessions to suit your individual needs but also the need of the group and to ensure that you practice safely.

Any information you give will be treated in the strictest confidence and will not be shown to anyone else.

Some little tips to get the most out of your class:

  • Try not to have a big meal two hours prior to sessions
  • Wear loose, comfortable clothes
  • Drink plenty of water before, during and after sessions
  • Bring with you an open mind, love and joy
  • Most of all enjoy and smile, this is your time!

    Age group
    Under 1617-3435-4445-6465+

    Are you currently taking medication?

    Do any of these health conditions apply to you?
    High/Low Blood PressureEpilepsyAsthmaHeart ProblemsDepressionIBSOsteoporosisJoint ProblemsSpine IssuesRecent PregnancyMigraineRecent Fracture/SprainArthritisBack ProblemsDiabetesNeck ProblemsHerniaEye ProblemsKnee Problems

    What would you like from your yoga class?
    RelaxationBreath WorkWeight LossStress ReliefMeditationBody AwarenessAid InsomniaAid FatigueStrength & FlexibilityBetter PostureMental/Emotional WellbeingBecome more balanced

    Would you be interested in any of the following?
    1 Day WorkshopsWeekend Retreats1-2-1 Yoga