Health Form Name *FirstLastDate of birth *Emergency contact name *Emergency Contact Number *These conditions require specific modifications to your yoga practise. Please check any that applyAbdominal disorderRecent surgeryArthritisBack painKnee problemsHip problemsShoulder or neck problemsHeart disordersHigh blood pressureLow blood pressureThese conditions may affect your practise and so provide useful information to your tutorAsthmaDiabetesAuto-immune disorderEpilepsyAnxiety/DepressionSensory disorder affecting eyes or earsBalance affecting disorderOther (to be discussed with tutorAre you/could you be pregnant or have you given birth in the last 6 weeksYesNoHave you had any recent operationsYesNoNameSubmit
