Name *

First Name

Last Name

Please review this list and check those conditions that have affected your health either recently or in the past.

high blood pressure

low blood pressure

osteoporosis

diabetes

anxiety/depression

broken/dislocated bones

muscle strain/sprain

arthritis

scoliosis

disc problems

asthma, short breath

pregnancy

heart conditions

stroke

seizures

other? please explain below.

And lastly, what are your goals/expectations for your yoga practice?

Check all that apply.

strength training

flexibility

balance

stress relief

improve focus

manage weight

mindfulness

injury rehab

improve posture

manage reactivity/emotions

manage addiction/recovery

pregnancy

improve sport performance

By ticking this box, I accept the terms & conditions

TERMS & CONDITIONS "I understand that yoga classes are not substitutes for medical attention, examination, diagnosis or treatment. I should consult a physician or health care provider prior to beginning any activity program, including yoga. The instructor does not assume any responsibility for determining my fitness to participate in the class. I recognise that it is my responsibility to notify the instructor of any serious illness or injury before every class. If I feel any discomfort I will listen to my body. It is MY responsibility to ask for clarifications on anything that I do not understand, I agree to waive claims against any persons connected with my yoga practice for any injuries I may sustain and assume full responsibility for all my actions related to practice. I understand 24 hours cancelation is required or I will pay infill for the session.I understand and agree to the conditions set out above."