New Yoga Client Intake and Health History Form

Please fill out the following health declaration form in order to participate in our activity.
Have you practiced yoga before?
What styles of yoga have your pacticed before?
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What are your health goals for your yoga practice?
Which aspects of yoga are you most interested in?
Please review the following list ad check any health conditions that apply to you or have applied to you recently.
Are you currently taking any medications?

I authorize the collection and use of the above personal information as is required for therapeutic treatment and related administrative purpose. I understand that all my personal information is confidential and will not be released without my signed consent.

 

I understand that yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in yoga classes offered by Zen Lab. In addition, I will make my yoga instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Zen Lab.

Thanks for submitting!