Post natal yoga registration

Which class are you interested in

Name

Town

Telephone

Mobile

Email

Date and place you gave birth

Boy/girl/twins name(s)

Are you currently breast-feeding:
YesNo

Have you undergone: epidural/c-section/natural birth/water birth

List any particular conditions which may have affected your pregnancy or labour eg SPD/diabetes

Baby came late, low placenta etc

Have you done Yoga before?
YesNo

What style?

Have you done Pregnancy Yoga before?
YesNo

If yes, did it help you during labour?
YesNo

How?

What would you like to gain through post natal Yoga classes

Was this your first pregnancy?

If no, please give age of children

Previous difficulties/miscarriages?

If yes, please give details

Do you currently experience any of the following. Tick any relevant symptoms
TirednessSleep disturbancesSPDConstipationAnxiety / DepressionAching groinsAnaemiaDiabetesPilesLower Back PainSciaticaLow Blood PressureVaricose VeinsOedema (swollen joints)Diastasis rectiHigh Blood Pressure

Please give details of any other health issues you may encounter:

Last, have you suffered any injury or undergone any surgery (i.e. knee surgery) which could affect you Yoga practice? If so, please give details, thank you

Do you have any allergies or dietary requirements:
YesNo

If yes, what kind

How did you hear about the class?

Would you like to keep in touch with Marylines news of classes, workshops, audio and video material. If yes, we'll add you to our mailing list. Your details won't be shared with anyone else.

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Email: maryline@yogaspirits.co.uk

We’ll answer your query in the shortest time and hopefully get the chance to help you relax and strengthen for life!