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Pregnancy Yoga Student Health Questionnaire

Are you currently pregnant or have you given birth in the last 6 months:
Has your doctor said it is okay for you to participate in physical activities such as Yoga & Pilates?
If you are pregnant, are you pregnant with more than one child?
Have you had a major injury or operation in the last 5 years:
Are you allergic to anything, including essential oils:
During this pregnancy have you experienced the following? (Please seclect those that have affected you):

*Denotes a condition that is too serious to manage in a yoga class

What are you hoping to gain from attending sessions with me?
Have you practiced yoga, pilates, or other physical activities before?

  • 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 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.

  • I have read and agree to the Terms & Conditions.

Thank you for submitting your form!

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