Are you on any medication? Please list.
Describe your level of activity. How many days a week?
Do you a smoke? If yes, how often?
Do you a drink alcohol? If yes, how often?
Are you presently under a Physicians Care or other healthcare treatments?
Have you had surgery? If yes, which surgery?
Please indicate any other health concerns you wish your yoga teacher to know.
Autoimmune disease
Allergies/Sinus
Aneurysm
Anxiety
Arthritis
Back pain
Brain injury or TBI
Bulging Spinal Discs
Cancer
Clicking or Popping Ears/Jaw
Constipation
Depression
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Osteoporosis
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Dislocation
Fractures
Headaches / Migraines
Heart Disease
Herniated Discs
Hepatitis A/B or C
High/low blood pressure
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Joint problems
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Kidney/bladder problems
Liver/gallbladder problems/disease
Menstrual problems
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Neck Pain
Pregnant
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Consent for Yoga
It is understood that Yoga is a holistic and spiritual means to gain strength, mobility or relaxation. Yoga is not meant to diagnose, cure or treat any illness or disease, or any other physical or mental disorder, injury or condition. I have informed my instructor, Ashleigh, about my state of health and I have transmitted any recommendations and restrictions on the part of my medical doctor or therapist insofar as yoga is concerned.
