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Venetia Davidson Yoga

ONE TO ONE AND GROUP CLASSES IN SUSSEX OR ONLINE

Yoga Classes
Yoga Therapy
- Integrative Yoga Therapy
- 8 week Yoga Therapy Course for Stress, Anxiety and Depression
Contact

Venetia Davidson Yoga

New Client Questionnaire

If you are new to any of my classes please complete the New Client Questionnaire using the form below. Thank you.

Name *

First

Last

Email *

Phone *

Emergency Contact (neighbour, friend or relative) *

Do you take regular exercise?

Yes
No

If 'Yes' please clarify

Have you practiced yoga before?

Yes
No

If yes, for how long and what type?

Do you suffer from any of the following?

High Blood Pressure
Low Blood Pressure
Heart or chest problems
Epilepsy
Diabetes
Ear or eye problems
Back problems
Joint problems
Hiatus hernia
Anxiety
Migraine
Allergies
Any other relative ailments
Any recent operations
Could you be or are you pregnant?

If yes please explain

What would you like to gain from your yoga practice?

I sometimes assist students with hands on adjustment. Is this a problem to you? *

Yes
No

Declaration *

I declare that the information I have given is correct and will inform the teacher if there are any changes

Do you agree to my Terms (see below) *

Yes

Email

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