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Pregnancy Yoga Student Health Questionnaire

Are you currently pregnant or have you given birth in the last 6 months:
Has your doctor said it is okay for you to participate in physical activities such as Yoga & Pilates?
If you are pregnant, are you pregnant with more than one child?
Have you had a major injury or operation in the last 5 years:
Are you allergic to anything, including essential oils:
During this pregnancy have you experienced the following? (Please seclect those that have affected you):

*Denotes a condition that is too serious to manage in a yoga class

What are you hoping to gain from attending sessions with me?
Have you practiced yoga, pilates, or other physical activities before?
  • I have answered all questions honestly and to the best of my knowledge.

  • The information provided is accurate and reflects my current health status.

  • I have disclosed all relevant health information regarding my pregnancy that may impact my participation in yoga classes.

  • I understand I am responsible for the application of yoga practices in this class and during my personal practice throughout pregnancy.

  • I acknowledge that the yoga recommendations, techniques, and ideas presented in this class do not serve as a substitute for professional medical advice.

  • I understand that any use of the information or techniques presented is at my own discretion and risk.

  • I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

  • I have read and agree to the Terms & Conditions.

  • I understand that personal information collected about me that can identify me, such as my name or where I live, will not be shared.

  • I understand that written client information shall be kept for as long as the client attends classes with Holistic Healing Arts.

  • I understand that any original student intake forms may be digitised and stored securely (encrypted), permitting any printed originals to then be destroyed securely by means of shredding.

  • I understand that any authorised photos of myself, the student, will be retained and used indefinitely by the teacher, and remain the property of the teacher.

I am okay for my image to be used in marketing so that more people can see the benefits of yoga and mindfulness
If I provide a testimonial of Ashley and her services, I am okay if my name is used.

Thank you for submitting your form!

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In yoga, the Sangha represents the community of practitioners who come together on the path of self-discovery and transformation. By joining our Sangha, you'll connect with like-minded individuals who share your passion for wellness, offering support, encouragement, and inspiration every step of the way.

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This website, including its blogs, services, and products, provides information for educational and informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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