Thank you for taking the time to fill out the following registration form.

Previous Yoga experience is not necessary, answers to the following questions will help me assist you in your practice so you get the most benefits out of it, and remain comfortable throughout the sessions.

(All information you provide will remain confidential)
 
Name

Town

Telephone 
Mobile
Email

Date and place you gave birth:
Boy / Girl / Twins - name(s):
Are you currently breast-feeding:
Yes
No

Have you undergone: epidural / C- section / natural birth / water birth:
List any particular conditions which may have affected your pregnancy or labour: i.e. SPD - Diabetes -

Baby came late - low placenta etc:
Have you done Yoga before?
Yes
No
Which?
Have you done Pregnancy Yoga before?
Yes
No
If yes, did it help you during labour?
Yes
No

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?

Are you currently taking any form of medication?

If yes, please give brief details:

Do you currently experience any of the following: - tick any relevant symptoms-
Tiredness
Sleep disturbances
SPD
Constipation
Anxiety / Depression
Aching groins
Anaemia
Diabetes
Piles
Lower Back Pain
Sciatica
Low Blood Pressure
Varicose Veins
Oedema (swollen joints)
High 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.

How did you hear about the class: