YOGA QUESTIONNAIRE

      
               
           
               
  Please answer the following questions and return to me at the next class. All information will be strictly confidential  
               
   

Name:

          
               
    Address          
               
               
    Telephone Number   Mobile:      
               
    Do you have any medical conditions? Yes              No        Details    
               
    Have you recently had surgery?        
               
    Do you have any injuries?        
               
    Have you practised yoga before?        
               
    Do you have any back or other problems?        
               
    Do you have high or low blood pressure?        
               
    Do you suffer from asthma?        
               
    Are you pregnant?        
               
   

During the yoga class I may come round and gently adjust you to a better yoga position, do you have any objection to being touched by me?

        
               
    Is there anything else I should know, that may affect your yoga practice?        
               
    Is there anything else I should know, that may affect your yoga practice?        
               
    Please inform me if any of your details change    
               
    What would you like to gain from your yoga class; please tick all that apply:    
               
      Strength Flexibility Relaxation    
               
      Philosophy of Yoga Meditation Improved Concentration  
               
      Better Vitality Other ....Please give details    
               
               
               
      Karen  Clarke   February 2004