Health Declaration Form

Complete this declaration to confirm you are well enough for physical activity.

You undertake that you will cease an activity if it causes you pain or discomfort.

Some medical conditions, old or current, may affect your ability to practice, if you have any of the concerns listed below, you should check with your health professional that it is safe for you to practice yoga.

If you have had cause to take any pain relief medication, please do not attend as some medications can interfere with the bodies normal pain receptors which will greatly increase your risk of injury. This includes the use of ibuprofen.

Full Name

Email *

Phone *

Other information *

By submitting this form you confirm you are fit and able to practice.

You will be notified when you need to update your information but you should notify the yoga teacher, Lee-ann, as and when you have issues that may affect your practice.

Abdominal disorder, recent surgery, arthritis, back pain, knee problems, hip problems, shoulder or neck problems, heart disorders, blood pressure issues, anxiety / depression, balance-affecting disorder, pregnancy or recent childbirth.

lf you think you may be pregnant, have recently been pregnant or are undergoing fertility treatment, please let me know because there are some modifcations required for your comfortable your practise. You can be assured of my utmost discretion.

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