Physical Activity Readiness Questionaire

Please tell me about how you are doing physically and any issues you are dealing with.

Health Form*

	Yes	No
Have you tension, stiffness? List below
Have you an injury or a condition that may affect your practice?
Do you exercise/ move regularly? If so, list below
Can you get down and up off the floor easily?
Do you have asthma?
Do you have diabetes?
Do you have high blood pressure?
Low blood pressure/fainting?
Do you have back problems?
Neck problems?
Shoulder problems?
Knee problems?
Wrist problems?
Migraines?
Depression?
Have you ever experienced chest pains when exercising?
Have you had any surgery in the last few years?
Are you pregnant?
Have you recently been pregnant?

If you said Yes to any of the above, please give details for all:
Age group*
Do you have experience in yoga?*
Tell me about your experience and what level you are at:
Tell me about your typical waking day, I want to know your movement/postural routines. Eg 70% sitting looking at a screen - I cross my left over my right leg, 20% walking, 10% running, 10% gardening etc
What do you want to get out of the course/coming to class?
Any other comments
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