Health Form

First name

Last name

Age

Phone

Have you practised yoga before? Please give details of how long, what style of yoga etc.

What are you hoping to gain from the course?

Do you have any illness, medical condition or disability? If so, please state details.

Have you suffered any injury or undergone any surgery which may affect your yoga practice? If so, please state details.

Are you taking any form of medication that may have some bearing on your yoga practice? If so, please state details.

Please note: participation in these yoga classes is entirely at your own risk and the instructor is released from any liability. Please modify or stop any exercises if you experience discomfort or pain, and consult with a healthcare provider if you have concerns about your ability to safely engage in this yoga practice. Please keep the teacher informed if your health condition changes.

Signature

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