{"id":161,"date":"2018-05-07T22:12:20","date_gmt":"2018-05-07T22:12:20","guid":{"rendered":"http:\/\/venetiadavidsonyoga.co.uk\/?page_id=161"},"modified":"2021-05-10T14:01:14","modified_gmt":"2021-05-10T14:01:14","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/venetiadavidsonyoga.co.uk\/?page_id=161","title":{"rendered":"Questionnaire"},"content":{"rendered":"<p>If you are new to any of my classes please complete the Pre Course Questionnaire using the form below. You can also <a href=\"https:\/\/venetiadavidsonyoga.co.uk\/wp-content\/uploads\/2021\/05\/Pre-Course-Questionnaire.doc\">download<\/a> a copy. Thank you.<\/p>\n<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-166\"><form id=\"wpforms-form-166\" class=\"wpforms-validate wpforms-form\" data-formid=\"166\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F161\" data-token=\"5a3fbb29f04911b6ccffa1bca34dfdd4\" data-token-time=\"1787839520\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-166-field_3-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"3\"><label class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-166-field_3\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][3][first]\" required><label for=\"wpforms-166-field_3\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-166-field_3-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][3][last]\" required><label for=\"wpforms-166-field_3-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-166-field_23-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-166-field_23\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-166-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" required><\/div><div id=\"wpforms-166-field_22-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-166-field_22\">Phone <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-166-field_22\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][22]\" step=\"any\" required><\/div><div id=\"wpforms-166-field_26-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-166-field_26\">Emergency Contact (neighbour, friend or relative) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-166-field_26\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][26]\" step=\"any\" required><\/div><div id=\"wpforms-166-field_10-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"10\"><label class=\"wpforms-field-label\">Do you take regular exercise?<\/label><ul id=\"wpforms-166-field_10\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_10_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][10][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_10_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_10_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][10][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_10_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-166-field_12-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-166-field_12\">If &#039;Yes&#039; please clarify<\/label><textarea id=\"wpforms-166-field_12\" class=\"wpforms-field-small\" name=\"wpforms[fields][12]\" ><\/textarea><\/div><div id=\"wpforms-166-field_13-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"13\"><label class=\"wpforms-field-label\">Have you practiced yoga before? <\/label><ul id=\"wpforms-166-field_13\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_13_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"Yes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_13_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_13_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][13][]\" value=\"No\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_13_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-166-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-166-field_14\">If yes, for how long and what type?<\/label><textarea id=\"wpforms-166-field_14\" class=\"wpforms-field-small\" name=\"wpforms[fields][14]\" ><\/textarea><\/div><div id=\"wpforms-166-field_17-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"17\"><label class=\"wpforms-field-label\">Do you suffer from any of the following?<\/label><ul id=\"wpforms-166-field_17\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_1\" name=\"wpforms[fields][17][]\" value=\"High Blood Pressure\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_1\">High Blood Pressure<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_2\" name=\"wpforms[fields][17][]\" value=\"Low Blood Pressure \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_2\">Low Blood Pressure<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_3\" name=\"wpforms[fields][17][]\" value=\"Heart or chest problems\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_3\">Heart or chest problems<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_7\" name=\"wpforms[fields][17][]\" value=\"Epilepsy \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_7\">Epilepsy<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_6\" name=\"wpforms[fields][17][]\" value=\"Diabetes\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_6\">Diabetes<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_5\" name=\"wpforms[fields][17][]\" value=\"Ear or eye problems\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_5\">Ear or eye problems<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_4\" name=\"wpforms[fields][17][]\" value=\"Back problems \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_4\">Back problems<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_9\" name=\"wpforms[fields][17][]\" value=\"Joint problems\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_9\">Joint problems<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_10\" name=\"wpforms[fields][17][]\" value=\"Hiatus hernia\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_10\">Hiatus hernia<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_11\" name=\"wpforms[fields][17][]\" value=\"Anxiety \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_11\">Anxiety<\/label><\/li><li class=\"choice-12 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_12\" name=\"wpforms[fields][17][]\" value=\"Migraine\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_12\">Migraine<\/label><\/li><li class=\"choice-14 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_14\" name=\"wpforms[fields][17][]\" value=\"Allergies \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_14\">Allergies<\/label><\/li><li class=\"choice-13 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_13\" name=\"wpforms[fields][17][]\" value=\"Any other relative ailments\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_13\">Any other relative ailments<\/label><\/li><li class=\"choice-16 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_16\" name=\"wpforms[fields][17][]\" value=\"Any recent operations \"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_16\">Any recent operations<\/label><\/li><li class=\"choice-15 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_17_15\" name=\"wpforms[fields][17][]\" value=\"Could you be or are you pregnant?\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_17_15\">Could you be or are you pregnant?<\/label><\/li><\/ul><\/div><div id=\"wpforms-166-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-166-field_18\">If yes please explain<\/label><textarea id=\"wpforms-166-field_18\" class=\"wpforms-field-small\" name=\"wpforms[fields][18]\" ><\/textarea><\/div><div id=\"wpforms-166-field_19-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-166-field_19\">What would you like to gain from your yoga practice?<\/label><textarea id=\"wpforms-166-field_19\" class=\"wpforms-field-small\" name=\"wpforms[fields][19]\" ><\/textarea><\/div><div id=\"wpforms-166-field_20-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-list-2-columns\" data-field-id=\"20\"><label class=\"wpforms-field-label\">I sometimes assist students with hands on adjustment. Is this a problem to you?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-166-field_20\" class=\"wpforms-field-required\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_20_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][20][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_20_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][20][]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_20_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-166-field_21-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"21\"><label class=\"wpforms-field-label\">Declaration <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-166-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_21_1\" name=\"wpforms[fields][21][]\" value=\"I declare that the information I have given is correct and will inform the teacher if there are any changes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_21_1\">I declare that the information I have given is correct and will inform the teacher if there are any changes<\/label><\/li><\/ul><\/div><div id=\"wpforms-166-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"28\"><label class=\"wpforms-field-label\">Do you agree to my Terms (see below) <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-166-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-166-field_28_1\" name=\"wpforms[fields][28][]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-166-field_28_1\">Yes<\/label><\/li><\/ul><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-field wpforms-field-hp\"><label for=\"wpforms-166-field-hp\" class=\"wpforms-field-label\">Website<\/label><input type=\"text\" name=\"wpforms[hp]\" id=\"wpforms-166-field-hp\" class=\"wpforms-field-medium\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"166\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/161\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><div class=\"activelayer-env-wrap\" aria-hidden=\"true\" style=\"position:absolute!important;left:-9999px!important;top:-9999px!important;width:1px!important;height:1px!important;overflow:hidden!important;opacity:0!important;pointer-events:none!important;\"><input type=\"text\" name=\"activelayer_env_signals\" value=\"\" class=\"activelayer-env-signals\" autocomplete=\"off\" tabindex=\"-1\" \/><\/div><div class=\"activelayer-behavioral-wrap\" aria-hidden=\"true\" style=\"position:absolute!important;left:-9999px!important;top:-9999px!important;width:1px!important;height:1px!important;overflow:hidden!important;opacity:0!important;pointer-events:none!important;\"><input type=\"text\" name=\"activelayer_behavioral_signals\" value=\"\" class=\"activelayer-behavioral-signals\" autocomplete=\"off\" tabindex=\"-1\" \/><\/div><div class=\"activelayer-hp-wrap\" aria-hidden=\"true\" style=\"position:absolute!important;left:-9999px!important;top:-9999px!important;width:1px!important;height:1px!important;overflow:hidden!important;opacity:0!important;pointer-events:none!important;\"><label class=\"activelayer-sr-only\">Leave this field empty<\/label><input type=\"email\" name=\"al_hp_email\" value=\"\" class=\"activelayer-hp-field\" autocomplete=\"off\" tabindex=\"-1\" \/><\/div><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-166\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><\/div><\/form><\/div>  <!-- .wpforms-container -->\n","protected":false},"excerpt":{"rendered":"<p>If you are new to any of my classes please complete the Pre Course Questionnaire using the form below. You[&#8230;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-161","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/161","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=161"}],"version-history":[{"count":22,"href":"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/161\/revisions"}],"predecessor-version":[{"id":338,"href":"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=\/wp\/v2\/pages\/161\/revisions\/338"}],"wp:attachment":[{"href":"https:\/\/venetiadavidsonyoga.co.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=161"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}