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HEALTH
QUESTIONNAIRE

Please fill out the following form to help us understand your physical condition.

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All the information will be treated as strictly confidential. As with all exercise programmes, it is advised that you contact your GP prior to attending your first appointment.

Birthday
Day
Month
Year
Do you take regular exercise?
Yes
No
Have you practiced Yoga before?
Yes
No
Are you pregnant?
Yes
No
Have you had an operation in the last 12 month? *
Yes
No
Are you taking any medication? *
Yes
No
Please indicate if you have suffered or continue to suffer from any conditions that would impact your ability to practice yoga.

Please note that Yoga Therapy is a complementary Therapy and is to be used in conjunction with medical advice provided for you by your GP or other professional body.

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Please indicate that you have understood that Tree Of Life Yoga Northants can take no responsibility for your medical health and that you have been guided by your GP as to whether it is safe for you to practice Yoga Therapy:

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