Consent to Practice

Please fill out the following form to help us understand if you have any health concerns we need to know about. This helps us to look after you, to provide the best class most suitable to your needs and tailor ever session for each individual in the class.

Your Name

Your Address

Your Email

Emergency Contact Telephone Number

Occupation

Doctors Practice, Name and Number

Preferred Contact Telephone Number

Emergency Contact Details

Current Level Of Fitness - Low, Moderate, High - Give examples of what exercise you currently do. e.g - Walk the dog 30 minutes daily, Go for a run 10 minutes weekly, Cycle some weekends, Go to the gym 3 times a week.

Do you suffer, or have you ever suffered, from any of the following:

Diabetes

Kidney problems

Epilepsy

Surgery or injury to back or joints

Sensitive skin

Allergic skin rashes

Heart disease

Allergies

High or low blood pressure

Cancer

Stroke

Asthma

Migraines

Please Give Details

Are You Pregnant?

Yes

No

Maybe

Please Give Details

Do You Have Any Experience of Yoga, Pilates or Meditation? Please give details below

I Would Love To Receive Your Monthly Newletters and Exclusive Offers SENT OUT AT MOST ONCE A WEEK

GDPR and Declaration

Your Signature

Select Today's Date

Thank You for filling in your health form!

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