Yoga Class Registration Form

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One Body Physical Therapy, PLLC; Cathleen deSmet, PT, PRC, RYT 500

Email *

Please list Name, Age and Pronouns *

Phone number *

Emergency Contact Name, Phone # and Relationship to you. (If you are under 18 years of age, this must be your parent or guardian) *

Have you practiced yoga before? If so, how long and would you describe yourself as a beginner, intermediate, experienced or a teacher? *

Please describe any medical conditions, limitations, injuries or specific abilities you would like me to know about. *

Please list if you have any of the following:

*Eye conditions such as Glaucoma

*Uncontrolled high blood pressure

*Cardiac conditions

*Pulmonary conditions

*Neurologic conditions

*Diabetes Type I or II (if yes, do you have any concerns about your blood sugar response or management in a yoga class?)

*POTS

*Possibility you are pregnant

What brings you to the practice of Yoga? Do you have specific hopes for practice?

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