Health Questionnaire

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

Full Name

Emergency Contact Name

Email Address

Emergency Contact Number

Have you practiced yoga before?

Yes

Do any of the following health conditions apply to you? High Blood Pressure, Low Blood Pressure, Fainting, Arthritis, Diabetes, Epilepsy, Heart Problems, Asthma, Depression, Eye Problems, Recent Operation or Injury, Back Problems, Knee Problems, Neck Problems, Recent or Current Pregnancies

Yes

If you answered yes to the above question, please elaborate

Signature

Today's Date

I confirm that I take full responsibility for my health & that of any participents I book on behalf of, during the participation of any activity provided by Katie Winder Yoga either online or in person. I confirm that all the information provided above is correct & up to date to the best of my knowledge. Should my health or contact details change I will inform my yoga teacher of these changes. I release any liability from Katie Winder Yoga in the event of injury or illness. I agree to the privacy policy and the use of my data, all medical information is for private use only. We will not share any medical information at any time.View Privacy Policy

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