Yoga Registration Form

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Type a question

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or a heart condition or other serious illness?
Have you had surgery in the past 6 months? If so give details.
Are you pregnant or have you been pregnant within the last 5 months?

If you answered 'YES' to any above, please give details.

The Contraindications

Do you know of any other reason (including the following) why you should not do physical activity?

Absolute Medical Conditions

*Acute diseases / Inflammation processes
*Wearing a pacemaker
*Acute thrombosis conditions
*Fresh wounds resulting from an operation or surgical intervention
*Osteoporosis in an advanced stage

Non-absolute Medical Conditions

*Migraine / Epilepsy / Retinal *Problems
*Acute hernia, discopathy, spondylolysis
*Cardio-vascular disease
*Wearing recently fitted IUD’s, coils, metal pins, bolts or plates
*Gall and kidney Stones
*Synthetic joints

If any of the above or other reason applies to you, write details here.

Any other information you might feel is relevant:

If you have answered yes to any of the above questions, then you are required to gain consent from your doctor before participating in the yoga programme.

You are advised to postpone entry into the programme if you feel unwell or have a temporary illness. You must inform your gym instructor of any changes to your health status, whilst engaged in your training programme.

CONSENT: I confirm that I have read & understood the Contraindications (none of which apply to me), the Informed Consent wording and have answered ‘no’ to all questions in the Health Questionnaire. I confirm that I will notify the trainer if there is any change in my health or circumstances, which might impact on my ability to attend any yoga program.

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Yoga Registration - Winter 2025

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