Health Questionnaire

Welcome to your Health queationnare

Name
Surname
Age
Have you done yoga before?

If yes, what types and for how long?
What is your main reason for wanting to do yoga?

Which aspects of yoga most interest you (please tick as many as you wish):

Other aspects (please say which):
Do any of these health conditions apply to you?
High blood pressure
If yes, please give details
Low blood pressure / fainting
If yes, please give details
Arthritis
If yes, please give details
Diabetes
If yes, please give details
Epilepsy
If yes, please give details
Heart problems
If yes, please give details
Asthma
If yes, please give details
Depression
If yes, please give details
Detached retina/ other eye problems
If yes, please give details
Recent fractures / sprains
If yes, please give details
Recent operations
If yes, please give details
Back problems
If yes, please give details
Knee problems
If yes, please give details
Recent pregnancies
If yes, please give details
Are you pregnant?
If yes, please give details
Do you have any other conditions which affect your mobility or are likely to cause you concern whilst practising yoga
If yes, please give details
How did you first hear about this class?

“May you be strong enough to be gentle.”