Yoga Medical Form | Surf School Wales

YOGA PHYSICAL ACTIVITY READINESS
QUESTIONAIRE

Every customer must complete this. It’s only required once unless any of your details change.

First Name

Date of Birth

Last Name

Phone

Name of emergency contact

Contact number for emergencies

Do you have any medical conditions and if so do you take any current medication (In particular for a blood pressure or heart condition)

Details of any Injuries/Surgeries

If your doctor has ever said you have a heart condition and that you should only perform physical activity recommend by a doctor - please give details below.

If you ever lose your balance because of dizziness or ever lose consciousness - please give details below

If you ever feel pain in your chest when you perform physical activity - please give details below

If you have a bone or joint problem that could be made worse by a change in physical activity - please give details below

I declare that the information I’ve provided is accurate & complete and any questions that have been left blank if there is nothing to share

Thanks for submitting!

YOGA PHYSICAL ACTIVITY READINESS QUESTIONAIRE

YOGA PHYSICAL ACTIVITY READINESS
QUESTIONAIRE