New Customer Registration Form
Clifton Hill Yoga Studio - Therapy Class
Customer Details:
Full Name
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First Name
Last Name
Phone Number
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-
Area Code
Phone Number
E-mail
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example@example.com
How did you hear about us?
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Please Select
Newspaper
Internet
Magazine
Other
Please Specify
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Please give details of the injury or illness you are seeking help for
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If you practice yoga, please give details on how this affects your practice or specific poses
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Please outline any relevant medical history
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Are you currently taking any prescribed medication? Provide details.
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DISCLAIMER: I understand that yoga is a physical activity and I engage in this class at my own risk. Please also remember to book into your class online. https://iyoga.punchpass.com/classes
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