Sheffield Yogi
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Health & Readiness Form

Please complete this form before attending your first class. All information is kept strictly confidential and will only be used to ensure your safety and wellbeing during sessions.

Personal Details
Section A — Cardiac & Circulatory

If you answer Yes to any question in this section, please obtain written approval from your GP before attending class.

Has a doctor ever told you that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness, or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by physical activity?
Are you currently taking medication for blood pressure or a heart condition?
Do you have high or low blood pressure?
Section B — General Health

If you answer Yes to any question in this section, please provide details in the box below.

Do you have a detached retina or glaucoma?
Have you had surgery within the last year?
Do you have any muscular, skeletal, or joint injuries or ongoing conditions?
Do you have diabetes?
Do you have any respiratory conditions such as asthma?
Are you currently experiencing significant stress, anxiety, or depression?
Do you have epilepsy?
Additional Questions
Are you pregnant or possibly pregnant? (Note: yoga classes are not suitable during pregnancy)
Have you given birth in the last 12 months?
Have you practised yoga before?
Do you have any allergies we should be aware of?
Are you currently feeling unwell?
Declaration

By submitting this form I confirm that: