Yogasmiths Student Health Questionnaire | Yoga Health Questionnaire |

Please complete the online Yogasmiths Student Health Questionnaire below. Once you have completed all relevant fields press the submit button at the end. We will receive your form and review the details that you have provided. In some situations we may have to contact you to clarify some point or to ask for further information.

You can also use this online form to inform us of any new health conditions or to update your personal information if you have moved address, changed phone number or for new emergency contact details.

You can find details of our online classes in our shop page https://yogasmiths.org/shop/ and also in our events calendar https://yogasmiths.org/events-calendar/.

Name *

First

Last

Date of Birth

Full Address including post code

Telephone Number - Mobile and/or Land Line

Email *

Emergency Contact Name

Emergency Contact Telephone Number

Have you attended a yoga class before?

If Yes, how long have you practised yogaand what style of yoga have you practised?

Further information

Please tick in this box if you do not wish to declare medical information. Please be aware that your yoga teacher cannot give any modifications or alternatives that may be appropriate, for conditions that have not been declared.

I do not wish to declare medical information

Have you had any recent operations (in the last two years)?

If Yes, please provide further information

Do you have any old injuries that still trouble you? Or any other medical condition not covered above that might be adversely affected by yoga practice?

If Yes, please provide further information

Are you / could you be, pregnant, or have you given birth in the last six weeks?

Do you participate in any other physical activity, e.g. gym, jogging, swimming, aerobics, cycling, walking or other? How regularly do you do this?

How did you hear about this class?

Disclaimer - tick the box to confirm your understanding and acceptance of our disclaimer *

I confirm my understanding and acceptance of this health questionnaire and its disclaimer

Please take care when filling in this questionnaire and check the contents are accurate before you submit it. By submitting the questionnaire, you are confirming that the contents are true and accurate to the best of your knowledge. Please notify your teacher of any changes to your responses in this healthcare questionnaire before participating in classes subsequent to those changes.
Neither your teacher nor the British Wheel of Yoga are qualified to express an opinion that you are fit to safely participate in any British Wheel of Yoga organised sessions or any British Wheel of Yoga trained teacher’s yoga classes. You must obtain professional or specialist advice from your doctor before participating if you are in any doubt.
All of our yoga instructors are appropriately qualified or British Wheel of Yoga Accredited teachers, with high standards of teaching and best practice. Where possible, your teacher may offer suitable modifications or adjustments and practices to suit different levels of experience and ability.
Please always let the teacher know before the class if this is your first time practicing yoga or if you are not confident about your experience and/or ability. Where you are taking part in live-streamed classes, please note that the instructor may not be able to see you at all times. Where you have declared a health condition, please contact the teacher before the class if you would like to request that you are provided with suitable modifications or adjustments wherever possible. Please note, where you are taking part in a pre-recorded class, you will not be able to request specific adjustments or modifications.
In all classes whether face to face, live streamed remote or pre-recorded remote, always follow your teacher’s safety instructions and listen to your body. Where a movement or class is beyond your experience or ability, feels too difficult for you, or you experience any discomfort, please do not continue the movement or class.

Date of completion of questionnaire

GDPR Statement - In order to comply with the General Data Protection Regulations, it is necessary for me to check whether or not you are happy for me to retain your contact details, and to send you information that I think may be useful to you, including training and events, and relevant updates. I only hold information when it is necessary to do so in order for me to carry out my work, and when you have given me permission to do so. To ensure that I only communicate with you in the manner of your preferred choice, please will you indicate below, your agreement, or otherwise, to the following means of communication:

Email
Post
Telephone

Message

This Yogasmiths Student Health questionnaire is based on the British Wheel of Yoga Student Health Questionnaire. You can find further details about the British Wheel of Yoga on their website at https://www.bwy.org.uk/

IMPORTANT NOTICE – for online classes

Although there are tremendous benefits to overall health and wellbeing, yoga can be physically challenging. It carries with it risks that cannot entirely be eliminated. These include the risk of personal injury. The exacerbation of existing injuries or conditions. And also damage to property around you during your participation.

Please note that although you may appear on video link during the live stream of the class, the instructor may not be able to see you clearly or instruct you individually as is possible in a face to face teaching scenario.

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IMPORTANT NOTICE – for online classes

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