Register, Yoga, Integrated Massage, Health, Wellbeing

Why Yoga For Your Form

Please answer all questions.

Please fill in – if you are new

Please fill in – if you haven’t attended classes for over three months

Please fill in – if your circumstances have changed keeping us up to date

Full Name *

Gender *

DOB *

Email Address *

Contact Mobile Number

County & Country of residence *

Profession *

Where did you here of Emma and Escott Ltd? *

Where did you hear other.

Have you practiced yoga online before? *

Do you have a favourite posture (Asana) and why is this your favourite? *

In your own words what do you want to achieve from Yoga? *

What interests you about Yoga? *

Do you do any other sports? *

If yes please specify - sports

Do you have any of the below medical conditions that have either been diagnosed, are medicated, or treated by your GP? High blood pressure, Low blood pressure, Breathing conditions (i.e., Asthma, COPD), Heart conditions, Glaucoma, Diabetes, Cancer and remission, Osteoarthritis, Rheumatoid arthritis, Osteoporosis, Headaches, Migraines, Chronic fatigue / M.E Sciatica, Crones, Tinnitus, Dizziness, Nausea, Fibromyalgia *

If yes please specify - medical conditions

If you have any other medical conditions. Please specify

Have you had COVID-19? *

Have you had any operations that you are recovering from in the last 3 (three) months? Please specify *

Do you have any physical injuries that you feel would inhibit your practice or that you are choosing Yoga to support your rehabilitation? Please answer ‘yes’ or ‘no’ and give a description? Back, Hip, Knee, Ankle, Wrist, Shoulder, Neck *

If yes please specify - physical injuries

Have you ever had any replacements? Please answer ‘yes’ or ‘no’ and give a description? Hip, Knee, Shoulder *

If yes please specify - replacements

Are you able to do the following with relative ease and comfort? Please answer ‘yes’ or ‘no’ and give a description? Breath through your nose, Lie on your back, Lie on your front, Lie on your right side, Lie on your left side, Stand, Stand on one leg with or without support of a wall, Sit on the floor with or without the support of a wall, Kneeling on all fours (hands and knees), Move from sitting on the floor to standing *

If no please specify - follow options

Is there anything else you think that we should know about yourself? *

If yes please specify - about you

Do you have any Injuries? *

If yes please specify - injuries

Have you seen a medical practitioner about your injury? *

If yes please specify - medical practitioner

Are you pregnant? *

Please subscribe to emails *

Confirm you have read and agree to our T&C’s policy *

Click Here To Read Our Terms and Conditions

If you experience any changes to your health, please let your teacher know.

Love Emma