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Forms

Health Intake Form Part 2

InCasa Yoga

Ashleigh Walker

Yoga Therapeutic Specialist

Diabetes

 

Digestive problems

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Skin disease

 

Stroke/TIA

 

Tooth/Jaw pain/Clenching

 

Varicose vein

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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.

For each drop down, select a number or other selection option where you are experiencing pain or discomfort.

Thanks for submitting!

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