Health Questionnaire

General Yoga: Health Questionnaire for New Students

    Age Group

    Under 1617-3031-4546-5556-6566-8081-9091+

    Have you done Yoga before?

    If yes, what type(s) and for how long?

    What is your main reason for wanting to do Yoga?

    Which aspects of Yoga most interest you? Please tick as many as you wish:

    Physical postures (Asanas)Breathwork (Pranayama)RelaxationMeditationSpiritual AwakeningYoga PhilosophyChantingRecovery from Injury

    Do any of these health conditions apply to you?

    High blood pressure? YesNo

    If yes, please give details:

    Low blood pressure/fainting? YesNo

    If yes, please give details:

    Arthritis? YesNo

    If yes, please give details:

    Diabetes? YesNo

    If yes, please give details:

    Epilepsy? YesNo

    If yes, please give details:

    Heart problems? YesNo

    If yes, please give details:

    Asthma? YesNo

    If yes, please give details:

    Depression? YesNo

    If yes, please give details:

    Detached retina/other eye problems? YesNo

    If yes, please give details:

    Recent fractures/sprains? YesNo

    If yes, please give details:

    Recent operations? YesNo

    If yes, please give details:

    Back problems? YesNo

    If yes, please give details:

    Knee problems? YesNo

    If yes, please give details:

    Neck problems? YesNo

    If yes, please give details:

    Recent pregnancies? YesNo

    If yes, please give details:

    Are you pregnant? YesNo

    If yes, please give details:

    Do you have any other conditions which affect your mobility or are likely to cause you concern when doing Yoga?

    YesNo

    If yes, please give details:

    How did you first hear about Yoga with Cate?