appleyoga Health Form

Registration form for appleyoga students

All information will be treated in the strictest confidence.

required field = Required

Name required field
Occupation required field
Phone (work) required field
Phone (home) required field
Date of Birth required field
Email required field

Have you practiced yoga before? Please give details of how long, what style of yoga etc.
Physically where would you say your strengths are and your weaknesses?
What are you hoping to discover or work with on the course, this could relate to mind, body and the beautiful spirit!
Do you have any illness, medical condition or disability? Yes No

If so, please state details.
Have you suffered any injury or undergone any surgery that may have some bearing on your yoga practice? Yes No

If so, please state details.
Are you taking any form of medication that may have some bearing on your yoga practice? Yes No

If so, please state details.

What would you identify as the major cause of stress in your life at the moment?

What do you usually do to relieve this stress?