Pre-Yoga Questionnaire | Welcome To Serenity

First name

Last name

Email

Phone

Emergency contact name and phone number

Please give details of any other physical activity you do:

Yoga is safe for the majority of people, however there are certain conditions which require special attention. If you're not sure please consult your GP beforehand. To help me ensure your safety when practising yoga, please tick any boxes below that apply

Are you pregnant, could you be or have you given birth in the last six weeks? *

Yes

No

Please give details of any injuries that could affect your ability to practice yoga:

Please tick to confirm that the information you've provided is accurate, that you agree it's your responsibility to check with your doctor if you have any concerns about practising yoga and that you are responsible for notifying me if any of this information changes:

Would you like to receive occasional e-mails with updates and offers?

Yes

No

This form collects and stores your details in line with our privacy policy and only for the purposes stated.