Yoga Consultation Form

🌸Blossom Sky Wellbeing Yoga Consultation Form🌸

First name

Last name

Phone number

Emergency contact phone number

Date of birth

Day

Month

Year

Have you practiced yoga before?

If yes, please provide details of the yoga you have practiced

If you answered YES to any of the above, please provide further details if necessary.

MEDICATIONS ~ Please provide details of any medications you are taking (this is relevant if we are using essential oils during our practice)

DISCLAIMER ~

Before starting a yoga session you should consult your GP about any physical conditions/symptoms you may be experiencing prior to attending. You should also tell Serena about any new conditions/symptoms that arise after completing this form.

If any movements hurt or are uncomfortable please stop and inform Serena, it is your responsibility to make certain that you never take your yoga practice to a level of discomfort or pain. It is your responsibility to take care of your body during yoga.

By signing this form you agree to indemnify Serena from any liability, losses, damages or expense arising from your participation in yoga and that the student assumes the risk of yoga practice and releases Serena from any liability claims.

I confirm that the information I have given on this form is true to the best of my knowledge. I have read, agree with, and will adhere to the above disclaimer.

Date

Day

Month

Year

Signature

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