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Sign In
My Account
Cart
0
Schedule
Classes
About
Pricing
Events
Contact
yoga circle
Yoga studio in Kitsilano
Health Questionnaire
Please read the 7 questions below carefully and answer each one by checking YES or NO
1) Has your doctor ever said that you have a heart condition OR high blood pressure?
*
YES
NO
2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
*
YES
NO
3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months.
*
Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).
YES
NO
4) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
*
YES
NO
If Yes, please list conditions here:
5) Are you currently taking prescribed medications for a chronic medical condition?
*
YES
NO
6) Has your doctor ever said that you should only do medically supervised physical activity?
YES
NO
7) Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active?
*
Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.
YES
NO
If Yes, please list conditions here:
Name
*
First Name
Last Name
Email
*
Thank you!
