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

Address: (Optional)

Telephone 
Mobile
Email

Current occupation:
Age

Due date & planned place of birth:
Have you chosen to give birth at home?
Yes
No
Have you done Yoga before?
Yes
No
If yes, how long have you been practising for:

What style:
Have you ever practiced Pilates?
Yes
No

Before you were pregnant, did you do any sport or type of exercise?
Yes
No
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
Yes
No

If no, please give age of children:

Previous difficulties/miscarriages?
Do you smoke?
Yes
No
Are you currently taking any form of medication?
Yes
No

If yes, please give details:

During this pregnancy, have you experienced any of the following:
Morning sickness
Headaches
Dizziness
Sleep Disturbances
Constipation
Heartburn
Breathlessness
Anxiety
Nosebleeds
Anaemia
Diabetes
Depression
Lower Back Pain
Sciatica
Aching Groins
PSD
Varicose Veins
Oedema (swollen joints)
High Blood Pressure
Pre-Eclampsia

 
Please give details of any of the above you have tick and or other health issues you may encounter below:
Last, have you suffered any injury or undergone any surgery (i.e. caesarean section, knee surgery) which could affect you Yoga practice? If so, please give details

How did you hear about the class: