New Therapy & Private Clients Please fill out and submit this form. Type ‘no’ if the question does not apply, or you prefer not to answer. Name(required) Email(required) Address Telephone number:(required) Age and Occupation(required) Please tell me a little about your current state of health.(required) Are you currently receiving any medical treatment or taking medication?(required) Please tick if you have any of the following conditions. Use the text box to tell me about any condition not mentioned or post-Covid symptoms you are experiencing.(required) Heart Disease Cancer or Benign Tumour Epilepsy Hypertension Depression ME MS Meniers Disease AIDS Diabetes Detached Retina Any post-operative conditions Low blood pressure High blood pressure Are you pregnant? Do you have any muscle or joint problems?(required) Have you had Covid and are you suffering as a result? Is there any other information that would be helpful, or do you have any questions? Please check with your medical practitioner before joining the classes if you have any medical conditions. Please type your name below to show that you have read and understood these questions.(required) Submit Δ
Iyengar Yoga Teaching & Training