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Student Health Questionnaire

Student Health Questionnaire

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. (Privacy Policy)

Date of Birth
Day
Month
Year
Have you attended a Yoga class before?
Yes
No

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 require specific modifications to your yoga practice:
These conditions may affect your practice and so it will be useful for your tutor to be aware of them:

Please tick in this box below if you do not wish to declare medical information.

Please be aware that your yoga teacher cannot give any modifications or alternatives that may be appropriate, for conditions that have not been declared.

Have you had any recent operations (in the last two years)?
Yes
No
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?
Yes
No
Are you /could you be, pregnant, or have you given birth in the last six weeks?
Yes
No
Do you participate in any other physical activity, e.g. gym, jogging, swimming, aerobics, cycling, walking or other?
Yes
No
How did you hear about Yoga with Lorraine?

Questionnaire Disclaimer

Please take care when filling in this questionnaire and check the contents are accurate before you submit it. By submitting the questionnaire, you are confirming that the contents are true and accurate to the best of your knowledge and the full disclaimer (found here) has been read and acknowledged.

Please notify your teacher of any changes to your responses in this healthcare questionnaire before participating in classes subsequent to those changes.

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GDPR Statement

In order to comply with the General Data Protection Regulations, it is necessary for me to check whether or not you are happy for me to retain your contact details, and to send you information that I think may be useful to you, including training and events, and relevant updates. I only hold information when it is necessary to do so in order for me to carry out my work, and when you have given me permission to do so. To ensure that I only communicate with you in the manner of your preferred choice, please will you indicate below by ticking, your agreement, or otherwise, to the following means of communication:

Multi choice

By clicking "Submit" I explicitly consent to the collection and processing of my health information by Yoga with Lorraine for the sole purpose of ensuring my safety and customising instruction during classes.

(Privacy Policy)

 

Yoga with Lorraine
Email: yogalorraine.email@gmail.com
Website: www.yogawithl.co.uk
Instagram: @yogawithlorraine

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© 2035 by Yoga with Lorraine | All rights reserved

 

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