Yoga Therapy Observation Client Sign Up Form
Minded are seeking clients who would be willing to take part in Observations taking place throughout the year. Minded run Observations from time to time, whereby we host a world-leading yoga therapist. They demonstrate their craft in their field of expertise, live on Zoom for others to observe, learn and grow from the experience. These yoga therapists are generally among the best in the world in their specialism, and they offer a truly unique opportunity to see yoga therapy in action. If you would like to be contacted about future opportunities to act as a client in our observations, please leave your details below and we will let you know when we are seeking new clients.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone
*
If you feel comfortable, please let us know of any past or current health conditions. This would help us reach out to interested parties if we are hosting an Observation focusing on a specific topic.
Rows
Current
Past
Arthritis
Back, shoulder / neck pain
Other back/spinal issues
Joint or muscle damage
Hypermobility
Osteoporosis / Osteopenia
High blood pressure
Eczema / Psoriasis / Rosacea /
Other skin issues
Low blood pressure
Varicose veins
Asthma
Allergy / hay fever
Other breathing difficulties
Stomach/ duodenal ulcers
Indigestion / Hiatus hernia
Constipation / Diarrhoea
Irritable bowel disorder/ IBS
Other digestive disorders
Premenstrual tension / PMDD
Fibroids / PCOS
Menopausal symptoms
Fertility issues
Pregnancy / childbirth difficulties
Menstrual difficulties/
Endometriosis
Genito-urinary issues
Heart problems
Other circulatory disorders
Sinusitis
Chronic bronchitis / Emphysema
Diabetes
Cancer
Migraines and headaches
Head injury
Epilepsy / Seizures
ME / Fibromyalgia / Excessive
fatigue
Neurodiversity (e.g., ADHD, ASD,
dyslexia, dyspraxia)
Sleep disorder /Insomnia
Stress
Depression
Anxiety
Addiction (e.g., alcohol, drugs, sex)
Eating disorder
Bipolar disorder
Schizophrenia
Other psychosis
PTSD / Trauma
Thoughts of suicide
Please provide any additional detail on your condition(s) that you feel might be relevant in the box below.
Are there any topic areas that you would like to see in a future Observation?
Confirmation
If you have any queries about our Observations, or if you would like to be removed from this mailing list at a future date, please reach out to admin@themindedinstitute.com
I confirm that the information I have given is a true and correct record and I give my consent to The Minded Institute processing this information in accordance with GDPR and the Data Protection Act 2018.
*
Yes
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