Booking PageBlissful Living Medical Questionnaire Please complete this prior to attending your first class.Name* First Last Date of Birth*Phone*Best phone number to contact in case of class changes or cancellationEmail* Enter Email Confirm Email Add to mailing list?YesNoWould you like to be added to the Blissful Living Mailing List?Have you practiced Yoga before?*YesNoYoga ExperienceHow long have you practiced yoga for? Type of Yoga (if known)What benefits are you hoping to gain from yoga Building Strength Increasing Flexibility Improved Posture Stress Relief Relaxation Mental/Emotional Wellbeing Improved Concentration Time for youTick all that applyDo any of these medical conditions apply? High Blood Pressure Low Blood Pressure Heart Issues Diabetes Arthritis Back Issues Neck Issues Eye Issues (detached retina, glaucoma etc) Knee Issues Joint Replacement Recent Fracture/Sprain Recent Operation Recent or current pregnancy IBS Osteoporosis Depression Anxiety Excessive or Chronic FatigueIf yes please give further conditions in the space provided belowFurther details about health conditionsDoes your condition affect you day to day? If so, how does it affect you? Is it likely to affect you in a yoga class setting?Student Agreement*YesI confirm that I have read and understood all the questions above and that I have supplied the correct information to the best of my knowledge.I take responsibility for myself during the yoga class and will inform the teacher of any changes to my state of health and medical conditions.