self assesment Health questionnaire
This information is required for your safety and to benefit your health.
High/Low blood pressure? Y N
Heart condition? Y N
Recent Operations? Y N
Varicose veins? Y N
Recent injury? Y N
Recent fractures/sprains? Y N
Arthritis? Y N
Epilepsy? Y N
Asthma? Y N
Detached Retina or other eye
problems?Y N
Abdominal/digestive complaint? Y N
Hernia? Y N
Any large swellings? Y N
Any Back problems? Y N
Any Neck problems? Y N
Any knee problems? Y N
Any Ankle Problems? Y N
Any Shoulder problems? Y N
Do you feel faint,have spells of severe dizzinee or lost consciousness? Y N
Are you pregnant? Y N
Has your doctor ever said you have any sort of condition and you should only do physical activity recommended by a doctor?
If you answered YES to one or more questions please talk to your doctor before you start participating in yoga or meditation classes with me.If there is anything you are unsure about or would like to chat through, please get in touch.
In all classes whether face to face or live streamed remote or pre-recorded remote, always follow your teacher’s safety instructions and listen to your body. Where a movement or class is beyond your experience or ability, feels too difficult for you, or you experience any discomfort, please do not continue the movement or class.
High/Low blood pressure? Y N
Heart condition? Y N
Recent Operations? Y N
Varicose veins? Y N
Recent injury? Y N
Recent fractures/sprains? Y N
Arthritis? Y N
Epilepsy? Y N
Asthma? Y N
Detached Retina or other eye
problems?Y N
Abdominal/digestive complaint? Y N
Hernia? Y N
Any large swellings? Y N
Any Back problems? Y N
Any Neck problems? Y N
Any knee problems? Y N
Any Ankle Problems? Y N
Any Shoulder problems? Y N
Do you feel faint,have spells of severe dizzinee or lost consciousness? Y N
Are you pregnant? Y N
Has your doctor ever said you have any sort of condition and you should only do physical activity recommended by a doctor?
If you answered YES to one or more questions please talk to your doctor before you start participating in yoga or meditation classes with me.If there is anything you are unsure about or would like to chat through, please get in touch.
In all classes whether face to face or live streamed remote or pre-recorded remote, always follow your teacher’s safety instructions and listen to your body. Where a movement or class is beyond your experience or ability, feels too difficult for you, or you experience any discomfort, please do not continue the movement or class.