Health Questionnaire

Please fill out this form before commencing your yoga practice with Leanne

First Name

Last Name

Email Address

Have you practiced Yoga before?

Yes

Are you currently suffering from a medical condition, illness, or injury?

Yes

Are you currently or have recently been pregnant?

Yes

If you answered yes to any question, please elaborate

Initials

Today's Date

My participation in any Yoga Class with Leanne Yardley is voluntary. The information I have given is correct to the best of my knowledge. The classes will consist of activities that are designed to gradually improve the efficiency with which the body functions, although no guarantee can be made. Options will be given but must be regulated by the student. It is down to the student alone to regulate their yoga practice and not push beyond any discomfort or pain. During the sessions, and for a period after, you may experience local muscular soreness and slight fatigue; these minor discomforts should disappear within 48 hours. As with any physical activity the reaction of the body to certain activities cannot always be predicted. There exists the risk that certain changes occurring during or following exercise, these include abnormalities in blood pressure, heart rate or in very rare cases cardiac complications. Should you feel unwell or unsure please let the teacher know immediately. All information acquired during the Yoga classes will be treated as confidential. You are free to stop the class at any time. Please make sure that before signing this form all your questions have been answered. Take as much time as you wish to think it over and if you wish, discuss your participation with you doctor.

Thanks for submitting!