Student Health Form

Student Health Form
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Any new exercise program should be undertaken with care - I strongly recommend you check with your Doctor/Health Provider if you suffer from any of the following. This list is by no means exhaustive and you should consult with your GP if you suffer any other condition not listed. Many of these conditions would not prevent you from practising yoga, in many cases it can support management of certain conditions, however it is important we practice safely and from a position of awareness.
Please indicate if you have any of the following and use the text box below to add further information which will help us work safely together

Multiple SclerosisDiabetesEpilepsyHigh blood pressureDizziness/VertigoHeart problemsInsomniaSciaticaOsteoporosisProne to faintingRecent whiplashAny inflammatory joint conditionNeck or back painHeadachesThyroid conditionHearing difficultiesMenopause symptomsAny breathing difficulty e.g. AsthmaOther
If you have answered yes to any of the above please provide any relevant information here:
Do you smoke?
Menstrual Health

Do you have a regular cycleAre you navigating perimenopauseAre you post menopauseNone of the above apply to meAre you pregnant
Have you had surgery in the last 12 months?
Have you had Covid and what are your ongoing needs?
Have you any previous experience of practicing yoga?

complete beginnersomeregular practiceyoga teacher
What are you goals in practicing yoga?
Thank you for completing this form. All personal information provided will not be shared with any other person or body and is only collected to support Louise in working with you and for insurance purposes. Your data will be stored in accordance with the GDPR legislation.
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