Alaró Postpartum Yoga Intake Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

Full Name *

I am registering for:

Postpartum Yoga Series in Full (18 Jan - 15 Feb) 65 €

Drop-in for Postpartum Yoga Series (18 Jan - 15 Feb) 15 €

Private Postpartum Yoga Session

Other:

Clear selection

How far postpartum are you currently? *

How would you describe your overall physical healing since your postpartum journey began? *

Do you experience any of the following? *

leaking urine when laugh, cough, sneeze or exert yourself

experience urgency to urinate, a feeling that you cannot make it to the toilet on time

leaking gas and not able to control

experience urgency to defecate, a feeling that you cannot make it to the toilet on time

experience a bulging or bearing down sensation in the vagina or perineum

Other:

Required

Do you have any known Diastasis Recti (separation of your abdominal muscles)? *

Yes

Maybe

Other:

Have you visited a Women's Health Physiotherapist since your postpartum journey began? *

Yes

Other:

Is there any physical condition, injury, limitation that you are experiencing in your body currently? *

Has your menses returned since your postpartum journey began? *

Yes

Other:

Will you be bringing your baby to the class? *

Yes

Maybe

Other:

Have you attended any of Amber's prerequisite programs or other programs to address core recovery following birth? *

Core Awakening Online

Core Awakening In-Person

Private Sessions with Amber

Other:

Required

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. Asana (yoga postures) means posture easily held. If at any time during the class, you feel discomfort or strain, gently come out of the posture. You may rest at any time during the class. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body and inform my teacher immediately. *

I agree

I disagree

I understand that Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I should consult a physician prior to beginning any activity program, including yoga. I recognise that it is my responsibility to notify my teacher of my pregnancy, of any serious illness or injury before every yoga class. I affirm that I alone am responsible to decide whether to practice yoga. I herby agree to irrevocably release and waive any claims that I have now or hear free may have against Amber Sawyer, PhD, E-RYT, E-500RYT *

I agree

I disagree

Please write your full name once more as an indication of your digital signature for this form. Thank you! *

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms