Private Yoga Student Assessment Form
Lifestyle & Health Information
Have you practiced yoga before?*
Do you have any current or past injuries or medical conditions that we should be aware of?*
Are you currently taking any medications that may affect your physical activity? *
Have you had any surgery in the last 5 years?*
How active are you in your daily life?*
Do you experience any regular aches or pains? (Check all that apply)
Are you aware of anything physical preventing you from practicing yoga?*
Do you have any allergies to scents, i.e. incenses, essential oils, etc?*
What type of yoga are you most interested in?
What is your preferred class intensity?
Your Yoga teacher may need to physically adjust you into the correct alignment of a pose during your practice. Are you comfortable with physical adjustments?*
Since Yoga covers the study of bodily health, mental control and spiritual awareness, please indicate which sections are of particular interest to you (please select one or more):
Every possible care will be taken by your teacher to ensure your well-being and safety but your teacher should be informed, BEFORE THE CLASS, of any recent injury, illness, surgery or commencement of pregnancy. Yoga is safe and beneficial when practiced CONSCIENTIOUSLY AND CONSCIOUSLY.
