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Student Health Questionnaire

Please fill out the following form to help us understand your physical condition.To be completed by yoga class participants for face to face and remote teaching. All
information given will be treated in the strictest confidence and stored in accordance with
General Data Protection legislation.

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Please contact Charlotte if you do not wish to declare medical information

The following information is required to ensure your health. Whilst yoga may be practised safely by most people, there are certain conditions that require special attention. If you are unsure, please consult your GP before commencing class. Please indicate in the boxes below whether or not you have any of the following medical conditions and then provide further information:
These conditions may affect your practice and so it will be useful for your tutor to be made aware of
Have you had any recent operations (in the last two years)?
Do you have any old injuries that still trouble you? Or any other medical conditions not covered above that might be adversely affected by yoga practice?
Are you /could you be, pregnant, or have you given birth in the last six weeks?
How did you hear about Charlotte Dugdale Yoga?

Thanks for submitting, Charlotte will discuss any other questions she may have with you in class

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