Name
*
First Name
Last Name
Email Address
*
Address
*
Phone Number
*
Preferred Contact
*
Please indicate your preferred method of contact in case of cancellation
Your Age
Baby's Name
Baby's Date of Birth
*
Do you have other children?
No
Yes
Emergency Contact Details
*
Was labour......
Nature of delivery ....
Any stitches required?
Since birth have you experienced any of the following?
*
If you have a known core separation, please state below any details below (eg finger separation etc)
*
If you had a caesarean birth, please describe to me how your scar/tummy is currently feeling?
Have you had a Mummy MOT?
If so with who and please let me know any details from the MOT, Thank You.
Prior to this birth, have you suffered any injury or undergone any surgery that may have some bearing on your yoga practice? If so, please state details.
How do you want to achieve after the course?
*
Is there anything else you would like me to know about, medical or otherwise?
Where did you hear about Body to Baby Yoga?
Client Declaration
*
CLIENT DECLARATION:
As far as I am aware, I have disclosed to my yoga teacher all information regarding my health relevant to the practise of yoga in the postnatal yoga classes.
I take full responsibility for all applications of yoga I practise in the class and outside the class.
I fully understand that the recommendations, ideas or techniques expressed and described in the postnatal yoga classes cannot be regarded as a substitute for the advice of a qualified medical practitioner.
Any uses to which the recommendations, ideas and techniques are put are at my sole discretion and risk.
