Post-Natal Health Questionnaire

Contact Details:

Name:(required)

Address:(required)

Best telephone:(required)

Email:(required)

Your date of birth:(required)

Birth Details:

Baby’s date of birth:(required)

Previous births?(required) Yes

Birth experiences – please give brief details of this most recent birth: (Tick boxes that apply to you)(required) Vaginal Delivery

Ventouse

Forceps

Caesarean

Any stitches required following tearing or episiotomy

Since the birth have you or your baby experienced any health conditions, undergone any surgery, suffered any injury or tare taking any form of medication that may have a bearing on your yoga practise? If so, please give details below:

Client Declaration:

I have disclosed all information regarding my health relevant to the practice of yoga and take full responsibility for all applications of yoga I practice in class or following a class at home online.

I fully understand that the recommendations, ideas or techniques expressed and described in class cannot be regarded as substitute for the advice of qualified medical practitioners.

I understand and consent that the personal information collected about me, such as my name or contact details, will be stored securely by Ryecroft Yoga and Wellness in accordance with our privacy policy and not be shared.

Click to accept the declaration (required)

I wish to be kept up to date with information on classes, events and news from Ryecroft Yoga and Wellness.