Yoga Soul Academy - Health Screening Questionnaire
To be completed by yoga class participants for remote teaching. All information given will be treated in the
strictest confidence and stored in accordance with General Data Protection legislation.

Full Name *
Email *
Date of Birth *
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The following information is required to ensure your health. Whilst yoga may be practised safely by most people, there are certain conditions that require special attention. If you are unsure, please consult your GP before commencing class. Please indicate in the boxes below whether or not you have any of the following medical conditions and then provide further information: These conditions require specific modifications to your yoga practice: *
If yes to any of the above, please provide further information: *
These conditions may affect your practice and so it will be useful for your tutor to be aware of them: *
If yes to any of the above, please provide further information: *
Have you had any recent operations (in the last two years)? *
Are you /could you be, pregnant, or have you given birth in the last six weeks? *
Do you participate in any other physical activity, e.g. gym, jogging, swimming, aerobics, cycling, walking or other? *
How regularly do you do this? *
How did you hear about Yoga Soul Academy? *
Do you wish to receive updates about the classes? (Please note, I will never share your information with anyone else, person or company, you may unsubscribe at any time) *
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