MyTimeYoga Health Form

Health Questionnaire
All information given will be treated in the strictest confidence and stored in accordance with Data Protection Legislation, including GDPR
Name

First NameLast Name
Address

House number/name

Street Address Line 2

Town/CityCounty

Post Code
Country
Home Phone Number

Area CodePhone Number
Mobile Phone Number

CarrierPhone Number
Email
example@example.com
Date of Birth

DayMonthYear
Emergency contact name
Emergency contact relationship
Have you attended a yoga class before?
How long have you practiced yoga?
If yes, what style of yoga have you practised? ( If known ) Tick all which apply

HathaYinVinyasaKundaliniDruOther
How did you hear about this class?
Do you participate in any other physical activity e.g gym, jogging, swimming, aerobics, tennis, cycling, walking or other? Please detail below with how often you do this per week?

Health Questionnaire