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Please fill out this health questionnaire

Please fill out the following form to help us understand your physical condition.

To be completed by yoga class participants for face to face and remote teaching. All information given will be treated in the strictest confidence and stored in accordance with Data Protection legislation.

Have you attended a yoga class before?

The following information is required to ensure your safety. Whilst yoga, Breathwork & meditation may be practised safely by most people, there are certain conditions that require special attention. If you are unsure, please consult your GP before commencing class. Please tick the boxes below if you have any of the following medical conditions. If you attending a Breathwork or massage session you may be required to complete a separate form in addition to this.

These conditions require specific modifications to your yoga practice. If yes, please give details.
These conditions may affect your practice and so provide useful information for your tutor.
How did you hear about us?


In order to comply with GDPR, it is necessary to check wether or not you are happy for us to retain your contact details, and to email you information we think will be useful to you, including, worskshop, events, trainings and, relevant updates. I only hold information when it is necessary for me to carry out my work and, when you have given me permission to do so. To ensure that I only communicate with you in the manner of your preferred choice, please indicate below your preference/s or otherwise, when contacting you.

Thanks for submitting!

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