Dru Yoga: Client Questionnaire

Thank you for your interest in my Dru Yoga classes. I am excited to welcome you as a student.

Please complete the following questionnaire prior to attending your first class.

Providing this information will help me to best care for you and your body in the classes and enable me to provide you with modifications and guidance during the class that will best suit your individual needs.

All information you provide will be treated in the strictest confidence. Please review my Privacy Policy if you have any concerns.

Do you have any back or neck pain?

Do you have any other joint pain?

Have you had any joint replacements?

Do you have any heart conditions or chest pains (especially if they are exercise induced)?

Do you have asthma or any other breathing difficulties?

Do you have high or low blood pressure?

Do you have epilepsy?

Do you ever feel faint or dizzy?

Do you have diabetes?

Do you have glaucoma?

Do you suffer from depression or anxiety?

Do you suffer from a lack of energy?

Do you have any other medical condition(s) requiring treatment?

Do you take any medication?

Are you able to stand unaided?

Are you able to get up and down from the floor unaided?

Are you able to lie on your back comfortably?

Are you able to position yourself on your hands and knees (on all fours) comfortably?

Are you able to lie on your front comfortably?

My general health is:

Have you ever practiced yoga before?

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