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Yoga Questionnaire For Yoga Students

This document is an information questionnaire for Trish Hardy Yoga. It collects contact information from prospective students such as name, email, address, date of birth, and occupation. It asks what motivated them to take yoga classes and whether they have previous experience. Students are asked to indicate medical conditions and treatments. They can note anything else that may affect their yoga practice. The form collects how students learned about the classes and has a signature line to opt into group emails from the instructor.

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SushantVRaikar
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531 views2 pages

Yoga Questionnaire For Yoga Students

This document is an information questionnaire for Trish Hardy Yoga. It collects contact information from prospective students such as name, email, address, date of birth, and occupation. It asks what motivated them to take yoga classes and whether they have previous experience. Students are asked to indicate medical conditions and treatments. They can note anything else that may affect their yoga practice. The form collects how students learned about the classes and has a signature line to opt into group emails from the instructor.

Uploaded by

SushantVRaikar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Trish Hardy Yoga

INFORMATION QUESTIONNAIRE
Dr/Mr/Mrs/Miss

Date: _____________________

Name: __________________________________

E-mail: ____________________

Address: ________________________________

Occupation: _______________

Telephone Number: _______________

Date of Birth: _____________

What made you decide to attend this Yoga Class?


(Please tick as many reasons as you wish, or add your own underneath)
To learn about Yoga (I am new!)
To improve physical fitness/flexibility
To aid relaxation
To aid stress management
Interest in the spiritual/philosophical area of Yoga
To help improve a medical condition
Other
Do you have any previous experience of Yoga? If yes, please describe.
Which areas of Yoga specifically interest you? (Please tick as many of the following
as you wish)
Physical relaxation
Postures and movements
Yoga Philosophy

Breath Techniques
Concentration and Meditation
Yoga lifestyle

Do you suffer or have suffered in the past from any of the following conditions?
Asthma
Heart Problems
High or Low Blood Pressure
Menstrual Problems
Depression
Panic Attacks

Migraine
Allergies
Arthritis
Spine problems e.g. Sciatica
Stress

Are you currently receiving any medical treatment?


Are you pregnant or attending the class immediately post-natal?
Yes/No
Is there anything else that you feel may affect your Yoga practice?
Yes/No

Yes/No

How did you learn about Yoga classes at Mount Pleasant or Bridgeland?
Please sign below if you accept receiving group emails from me. Your email will
not be shared.

________________________________________________(sign here)
Thank you for completing the questionnaire. Please note this information will be
kept confidential. If anything changes please let Trish know.

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