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Medical form 2021
Please could you complete the attached form before coming to Yoga or Pilates with Sandhya (previously Yoga Keynsham). thank you.
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Email
*
Your email
Name
Your answer
Age
20's
30's
40's
50's
60's
70 +
Other:
Clear selection
Occupation
Your answer
Whats the reason you want to come to a session?
*
Your answer
Have you attended a class before?
If yes please state how long (weeks, months, years)
Choose
No
once or twice
Yes, 1-12 months
Yes 1-2 years
Yes 2 years+
on and off several years
Please list below any medical or physical conditions / weak areas
*
Your answer
What's the biggest frustration about your injury / medical condition? (if appropriate) and If you have been to see a chiro / dr / physio regarding an ongoing injury/ condition please give details below
Your answer
How did you hear about the class
*
Google
Recommendation
Keynsham Voice
Wellbeing college
Poster
Facebook
Nextdoor
Other
can't remember
Option 9
Option 11
Other:
Required
Which class will you be attending?
Monday 5.30 Pilates
Mon 6.45pm Pilates
Tues 9.30 yoga
Tues - Stretch tone and relax
Wed Pilates
Thursday 5.30 Yoga
Wellbeing college course
https://www.wellbeingcollegebanes.co.uk/Calendar
121 session
Other
Option 10
Other:
If you previously attended a class do you have any comments / reviews on the class and how it has benefited you?
Your answer
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