Pregnancy yoga registration form

Your Name (required)

Your Email (required)

Address

Date of Birth YYYY-MM-DD (required)

Telephone no. (required)

Emergency contact

Your occupation

Due date (required)

Where are you planning to give birth?

How did you hear about the class?

Have you studied yoga before?

What do you hope to gain from the pregnancy yoga class?

Do you have any medical conditions, including psychological conditions such as depression or anxiety, or injuries, either prior to becoming pregnant or pregnancy-related eg pelvic girdle pain, epilepsy etc? Please give details.

Have you suffered any previous miscarriages or stillbirths?

Have you undergone surgery which could affect your yoga practice, eg knee replacement? Please give details.

Are you taking any medication?