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Private Sessions

Health Questionnaire for Private Yoga

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Yoga class date / time *

Date format ex: 2/1/18 10 - 11am

1. Do you have a history of the following conditions? *

Diabetes Irregular heartbeat Seizures Asthma Fibromyalgia Thyroid Disorder None of the Above Other

If Other please specify: *

2. Do you currently experience or have a history of the following injuries or orthopedic concerns? *

Joint Issues Arthritis Disc Issues Bursitis Low Back Pain Knee Pain Sciaticia Foot Cramps / Pain Tendonitis Ankle Sprains Nerve Pain Rotator Cuff Injury Shoulder / neck pain Hip pain None of the Above

3. Do you have any other medical condition(s) or issues with a particular aspect to your health/body not previously mentioned? *

Yes No

If Yes, please explain. *

4. Are you currently taking any medications? *

Yes No

If Yes, please explain. *

5. Current fitness activities and frequency – please describe: *

6. What is your main request for private Yoga session (s)? *

Emergency Contact *

First

Last

Please acknowledge *

Yes, I have answered the above questions to the best of my knowledge and have not withheld any relevant information.

Emergency Contact Phone *

Submit

Please contact us below to get a quote for Private Sessions with Teddi McEwen

Contact us for a quote

* Indicates required field

Name *

First

Last

Phone Number *

Email *

I am interested in information about Private Yoga session(s) *

Submit

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Home
FALL 2018
Winter 2019
- Register
CONTACT
- About Us
Upcoming retreats
- Past Retreats >
TESTIMONIALS
Exhale808