Health Declaration

Make sure you’ve filled out a Health Questionnaire before joining any of Fiona’s classes (online, recorded or in person). All information given will be treated in strict confidence and stored in accordance with the Data Protection legislation.

First Name & Surname

Email

Please TICK any health conditions below that apply to you, then give details in the 'more details' box. If none are applicable tick 'None of the above'.

Uncontrolled high blood pressure

Uncontrolled low blood pressure

Arthritis

Diabetes

Epilepsy

Asthma

Heart problems/chest pain

Back/knee/neck/joint problems

Back/Knee/Neck/Joint Problems (give details below)

Are you Pregnant or recently given birth? (give details of trimester or when)

Fainting or fits?

Detached Retina or Eye Problems

Anxiety/Depression/Mental Health

Any other conditions which affect mobility or could cause concern in you yoga class (give details below)

None of the above

Tick this box if you are happy to be ajusted in your yoga class (in person class only)

Please give MORE DETAILS here, or list any other conditions:

Have you practised yoga before? If 'yes' please give details.

Do you participate in any other physical activity, e.g. gym, jogging, swimming, aerobics, cycling, walking?

What is your main reason for wanting to do Yoga?

How did you hear about these classes?

Social Media (Facebook or other)

Poster

Friends/family

Google search

Word of mouth

Advert in magazine

Flyer

Other

Signature

I have answered honestly & to the best of my knowledge. I agree to update my teacher of any medical changes. I agree to take full responsibility for my health during the yoga classes, including any injuries. Signed (PRINT FULL NAME). I understand that I will receive occasional emails from FeeFloYoga (unsubscribe at any time)

Thank you for completing this form. Enjoy your classes!

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