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Venetia Davidson Yoga

ONE TO ONE AND GROUP CLASSES IN EAST AND WEST SUSSEX

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Venetia Davidson Yoga

Questionnaire

If you are new to any of my classes please complete the Pre Course Questionnaire using the form below. You can also download a copy. 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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Newsletter

By providing your E-mail Address I can keep you informed of any changes to my yoga classes and other information that you may find helpful. I will never pass on your E-mail Address and you can Unsubscribe at any time. Thank you!

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