A health questionnaire for attending Day Retreats and Workshops.
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Name
Have you had a major injury in the last 5 years: Yes/ No
Are you taking any prescribed medication: Yes/ No
Are you receiving treatment for any diagnosed medical conditions: Yes/ No
Have you had any recent operations: Yes/ No
The following conditions require specific modifications to your yoga practice. Please indicate below whether or not you have any of the following medical conditions.
Please indicate if you ever experience any of the following symptoms.
Are you currently pregnant or have you given birth in the last 6 months:
Are you vegan, vegetarian or pescatarian?
I agree that I have read and understood the terms and conditions and health questionnaire and confirm that I have answered all questions honestly and that the information given is correct and I acknowledge that I exercise at my own risk.