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YOGA QUESTIONNAIRE |
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Please answer the following questions and return to me at the next class.
All information will be strictly confidential |
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Name:
Address:
Telephone Number |
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Yes |
No |
Details |
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Do you
have any medical conditions? |
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Have you
recently had surgery? |
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Do you
have any injuries? |
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Have you
practised yoga before? |
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Do you
have any back or other problems? |
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Do you
have high or low blood pressure? |
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Do you
suffer from asthma? |
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Are you
pregnant? |
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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? |
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Is there
anything else I should know, that may affect your yoga practice? |
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Is there
anything else I should know, that may affect your yoga practice? |
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Please inform me if any of your details change |
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What would
you like to gain from your yoga class; please tick all that apply: |
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Strength |
Flexibility |
Relaxation |
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Philosophy of yoga |
Meditation |
Improved Concentration |
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Better vitality |
Other…. (please give details) |
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Karen Clarke |
February 2004 |
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