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  • Pre-Course Questionnaire

    Thank you for registering for an Eat Breathe Thrive course! This questionnaire is designed to help your course facilitator(s) cater the course to your unique personal needs and goals. Please complete and submit the questionnaire prior to your first session.

  • About You

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  • Ethnicity:*

  • Please specify your gender identity:*

  • Please specify your sexual orientation:*

  • What is your household income? (Please answer in the most appropriate currency)*
  • What is your household income?
  • What is your household income?

  • Course Details

  • Which Online Immersion are you registered for?
  • What is the name of your course facilitator?*

  • How did you hear about the course?*

  • Through which social media channel did you hear about the series?

  • Your Health Matters

  • The following conditions might require specific modifications for your yoga practice. Please tick any conditions that you experience from the list below:

  • Are you/could you be pregnant, or have you given birth in the last six weeks?
  • Do you have any old injuries that still trouble you?
  • This course deals with the topic of mental health. Do you experience any of the following? (Please tick all which apply)
  • Have you ever been diagnosed with an eating disorder?
  • Please check all which apply:

  • Have you received treatment for an eating disorder before?
  • Please select the type(s) of treatment you have received from the list below:

  • Your Professional Background

  • Do you teach yoga?*
  • Which type(s) of yoga? (Please tick all which apply)

  • Are you a mental health professional?*
  • What type of mental health professional are you?

  • Are you a health professional?*
  • What type of health professional are you?

  • Are you an educator?*
  • Which age group(s) do you teach?

  • Are you interested in becoming an Eat Breathe Thrive facilitator in the future?

  • Previous Experience of Yoga and Meditation

  • Have you practiced yoga before?
  • Which type(s) of yoga? (Please tick all which apply)

  • Have you practiced meditation before?
  • Do you have a regular meditation practice?

  • Emergency Contacts

    Emergency Contact 1

  •  -

  • Emergency Contact 2

  •  -

  • Your Goals

  • Should be Empty: