Online Yoga Medical Form
Please indicate if you experience any of the following:
Aches & PainsFluid RetentionMuscle FatigueAnxiety/StressHeadachesPalpitationsArthritisHeart ConditionPanic AttacksAsthmaHepatitis B or CP.M.TAthlete's FoolHigh blood pressureSinusitisBad CirculationHIV/AIDSSkin ProblemsBronchitisIndigestionSore ThroatsCoughs/ColdsInsomniaTensionConstipationsIrritable Bowl SyndromeThrushCystitisKidney ProblemsVaricose VeinsDepressionLow Blood PressureVerrucas/WartsDigestive ProblemsMenstrual problemsDiabetesMental FatigueEpilepsyMigrainesAre you pregnant?Other
Medical History: (Any major operations and/or broken bones..)
Current medication and/or Vitamins/Mineral Supplements:
Ability to relax: Very HardHardNot EasyEasyVery Easy
You may be asked to provide a letter from your doctor to confirm that you are fit to participate in yoga practice.
I declare the above medical details to be correct. I understand that any information I withhold could potentially have adverse effects for which I take full responsibility. If any changes occur including pregnancy, I undertake to keep my instructor informed now or any time in the future. I also understand that participating in online classes I do so entirely at my own risk.