Please kindly fill in the form bellow if you’ve never practiced yoga with me, before you take your first class, workshop or a retreat.

Rest assured that all information is strictly confidential and will never be shared.

Health Questionnaire

Thank you for taking the time to fill in this health questionnaire. Please be reassured that your details are treated with strict confidentiality.

Name
Emergency contact
Date of birth
Have you done yoga before?
Please check if any of the following apply
Please rate the amount of stress in your life
Are you pregnant?
Consent(Required)
MM slash DD slash YYYY