Sunrise Yoga Questionnaire

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All information enables the practitioner to provide you with yoga postures to suit your needs.

Your Yoga Instructor for the time being is Kaysen please email or call for any further questions. The data collected is used for the purpose of the Yoga sessions only. Quantitative data will be sent to our funders and partners where necessary only.

Thank you. Namaste

Kaysenasante@gmail.com

07760 876052

Email *

Record my email address with my response

What is your full name?

What is your age?

Have you done Yoga before?

Yes

Clear selection

If so, what type and how long for?

What is your main reasons for doing yoga?

Regarding your health, do you suffer from any of the following?

High Blood Pressure

Low Blood Pressure (fainting)

Arthritis

Diabetes

Epilepsy

Heart Problems

Asthma

Depression

Anxiety

Detached Retina/other eye problems

Hearing loss or impairment

Neck/Back and Knee problems

Recent operations last 2 years

Recent Fractures or sprains in the last 2 years

Are you pregnant or had a child within the last 3 months

Option 16

Do you have any other health conditions or conditions that affect your mobility and are likely to cause you concern when doing yoga?

Yes

Other:

Clear selection

If you answered yes or other please explain

It is important that you consult with your doctor if you are at all concerned about your physical or mental health. Please ensure that you inform your yoga practitioner of any medical changes?

Yes, I agree

The information you have provided is kept confidential and aligned with the GDPRS guidelines. The information provided will only be used to ensure yoga postures are suitable for you. Contact details are used to contact about sessions or information. I agree for the data to be held, stored and used appropriately to meet my needs for the yoga sessions. No information will be passed onto a third party.

Yes, I agree

Which sessions do you wish to attend?

Tuesdays 6pm-7pm (4 spaces left)

Mondays 7pm-8pm (4 spaces left)

Clear selection

I take full responsibility for myself when at yoga sessions and are fully responsible for any injury caused whilst at yoga sessions. I take for responsibility for my health and will not push my body any further that it is able to go.

Yes, I agree

It is not wise to do yoga under the influence of alcohol and drugs

Yes, I agree.

Clear selection

Date

YYYY

Signature (Please sign your name here)

Submit

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