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Jane Durkin Yoga: Health Questionnaire
Please take a moment to complete the following questions. This will enable me to adapt the class as best I can to any specific needs you may have. All information provided will be kept strictly confidential.
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Email
*
Your email
Name
*
Your answer
Briefly describe your yoga experience (if any). What style(s) have you practised? For how long?
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Your answer
What are you hoping to gain from your yoga practice?
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Your answer
Do you have any injury or medical condition that may affect your practice? Please give details.
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Your answer
Are you pregnant?
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Yes
No
Do you have asthma?
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Yes
No
Do you carry an epipen?
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Yes
No
Is there anything else that could affect your practice?
*
Your answer
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