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Mum + Baby Yoga Health Questionnaire

Have you got other children?
Are you currently pregnant:
Has your doctor said it is okay for you to participate in physical activities such as Yoga & Pilates?
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):
Have you practiced yoga, pilates, or other physical activities before
Are you allergic to anything, including essential oils?

  • 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.

  • I have read and agree to the terms and conditions.

  • ​I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thank you for submitting your form and sharing with me.

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