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HEALTH
QUESTIONNAIRE

YOGA HEALTH QUESTIONNAIRE

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

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

Do you take regular exercise?
Have you practiced Yoga before?
Are you pregnant?
Have you had an operation in the last 12 month?
Are you taking any medication?
How healthy do you feel in general? Please give a figure between 1-5, with 5 indicating full health
Please indicate if you have suffered or continue to suffer from any conditions that would impact your ability to practice yoga.

Thanks for submitting!

*
*
*

YOGA HEALTH QUESTIONNAIRE

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

​

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

Do you take regular exercise?
Have you practiced Yoga before?
Are you pregnant?
Have you had an operation in the last 12 month?
Are you taking any medication?
How healthy do you feel in general? Please give a figure between 1-5, with 5 indicating full health
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:

Thanks for submitting!

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