Have you ever had whiplash or neck problems?
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Yes
No
Do you have high or low blood pressure?
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Yes
No
Do you suffer from back pain or injury?
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Yes
No
Do you have a bone or joint problem (such as arthritis, bursitis, or osteoporosis) OR a joint injury that might be made worse by exercise?
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Yes
No
Do you suffer from diseases of the heart, lungs, kidneys or liver?
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Yes
No
Are you pregnant?
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Yes
No
Do you suffer from hernia?
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Yes
No
Are you taking any medications that might affect your ability to safely practice yoga?
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Yes
No
If you answered YES to any of the above questions, please explain more here
Do you have any other health/physical concerns, or is there anything else you want me to know? Please share here.
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By clicking the box below and typing your name, you are confirming that all of the above information is truthful and agreed upon. You also acknowledge your understanding that Yoga is not a medical procedure, and that the Yoga Teacher will not be providing a diagnosis of any medical problems or concerns you may have. You understand that Yoga is a process of integration intended to facilitate wholeness, body awareness and self awareness. You also understand that you are solely responsible for your health, safety and well-being. You agree that you will inform the Yoga Teacher of any activity or movement which you cannot safely perform, and that you will not perform any activity or movement which you feel is likely to cause you to injuire yourself. You agree to hold the Yoga Teacher harmless from any and all responsibility for any injury which you may sustain during or as a result of your Yoga sessions.
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