Pregnancy yoga registration

Which class are you interested in

Name

Town

Telephone

Mobile

Email

Occupation

Age

Due date & planned place of birth

Have you chosen to give birth at home?
YesNo

Have you done Yoga before?
YesNo

If yes, how long have you been practising for?

What style?

Have you ever practiced Pilates?
YesNo

Before you were pregnant, did you do any sport or type of exercise?
YesNo

If yes which

Are you currently doing any sport or type of exercise?

Which?

Why have you come to Yoga and what do you hope to gain from it?

Is this your first pregnancy?
YesNo

If no, please give age of children

Previous difficulties/miscarriages?

Do you smoke?
YesNo

Are you currently taking any form of medication?
YesNo

If yes, please give details

During this pregnancy, have you experienced any of the following
Morning sicknessHeadachesDizzinessSleep DisturbancesConstipationHeartburnBreathlessnessAnxietyNosebleedsAnaemiaDiabetesDepressionLower Back PainSciaticaAching GroinsPSDVaricose VeinsOedema (swollen joints)High Blood PressurePre-Eclampsia

Please give details of any of the above you have ticked and/or other health issues you may encounter

Have you suffered any injury or undergone any surgery (i.e. cesarean section, knee surgery, etc) which might affect your Yoga practice? If so, please give details

Do you have any allergies or dietary requirements:
YesNo

If yes, what kind

How did you hear about the class?

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Email: yogaspirits@hotmail.co.uk

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