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Health and Wellbeing Questionnaire

Please complete this short form before attending your first Pause and Bloom Yoga class.

Your answers help me understand your needs and make the class as safe, comfortable and supportive as possible.

Please tell me about anything that may be relevant to your practice, even if you're unsure whether it matters.

How your information is used

The information you provide is used by Pause and Bloom Yoga to help me understand your needs, adapt classes where appropriate and support your safe participation in yoga.

Some of the information requested is health information, which is considered sensitive personal data under UK data protection law. I will keep your information private and only use it for the purposes explained above.

Your information will be stored securely and will not be shared with third parties unless I am legally required to do so or it is necessary to protect your vital interests in an emergency.

Please see the privacy policy for further information about how your personal information is collected, stored and used, your rights, and how long information is retained.

Questions marked with a red asterisk () need an answer.

About You

If there’s a name you’d rather I use in class.

If you add one, I’ll send a short note to confirm this has arrived.

Your Health

If you answer yes to anything, a box will appear so you can tell me a little more. A sentence or two is plenty.

Do you currently have any pain, injury, stiffness or physical limitation that may affect your yoga practice?
Do you have any medical condition, recent surgery or other health consideration that I should be aware of before you practise?
Are you currently taking any medication that may affect exercise, balance, blood pressure, energy or alertness?
Have you experienced dizziness, fainting, unexplained shortness of breath, chest pain or unusual heart symptoms during exercise?
Are you pregnant, recently postpartum, or could you be pregnant?

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