YogaBirth Pregnancy Class Questionnaire

Please complete this form with as much information as possible. The information you provide is treated in the stricted confidence and is only used to enable me to plan and provide the most beneficial and safe class for you as an indevidual. If you would like to discuss anything please fell free to get in touch with me. 

Pregnancy Yoga Questionnaire
  • When is your estimated due date?:
  • Is this your first baby? :
  • Are you expecting twins:
  • Preferred contact method (in the unlikely event of a class being canceled):
  • During this pregnancy are you currently experiencing? :
  • What aspects of pregnancy yoga are you interested in?:
  • Declaration (see below) :

Declaration - By ticking the above box, I am declaring that I have disclosed to my yoga teacher all information regarding my health relevant to the practice of yoga during my pregnancy. I take full responsibility for all applications of yoga I practice in the class and outside the class during my pregnancy. I fully understand that the recommendations, ideas or techniques expressed and described in the pregnancy yoga classes cannot be regarded as a substitute for the advice of a qualified medical practitioner.