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Mum + Baby Yoga Health Questionnaire

Have you given birth before?
Are you currently pregnant:
Do you have a doctor’s permission to participate in intense physical activities?
Prior to this birth, have you suffered any injury or undergone any surgery that may have some bearing on your yoga practice?
Birthing experiences – Please give brief details, of your most recent birth by selecting the following options as they apply to you:
Since the birth of this baby have you experienced any of the following?:
Are you taking any form of medication that may have some bearing on your yoga practice?
What are you hoping to gain from this this class? (Please select all the apply):
  • I have answered all questions honestly and to the best of my knowledge.

  • The information provided is accurate and reflects my current health status.

  • I have disclosed all relevant health information regarding my pregnancy that may impact my participation in yoga classes.

  • I am responsible for the application of yoga practices in this class and during my personal practice throughout pregnancy.

  • I acknowledge that the yoga recommendations, techniques, and ideas presented in this class do not serve as a substitute for professional medical advice.

  • I understand that any use of the information or techniques presented is at my own discretion and risk.

Thank you for submitting your form!

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