University of BristolIyengar Yoga Classes

Medical Questionnaire – CONFIDENTIAL

IY classes are suitable for most people but IY teachers need to know about your general health and any medical conditions you might have. These classes are not suitable if you are already pregnant, please ask if you would like details of IY pregnancy classes.Pleasewrite clearly.

TitleFirst nameLast name

Contact numbers

Email

Emergency contact nameEmergency contact number

Please tick if any of the following apply and give details below:

Injury / Circulatory problems
Major illness or operation / Allergies
Heart condition / Diabetes
Arthritis or rheumatism / Migraine / headaches
Skin condition / ME / chronic fatigue
Epilepsy / Multiple Sclerosis
Meniere’s Disease / High blood pressure, hypertension
Detached retina / Varicose veins
Depression (or history of) / HIV
Anxiety / panic attacks / Stroke
Asthma / Any form of cancer
Frequent nose bleeds / Current medication
Back or neck trouble, other muscle or joint trouble / Pregnancy or given birth within last 12 months

If you have ticked any of the above or if there is anything else you think the teacher should know about, please give further details on the back.

Yoga the Iyengar method can help release tension and improve flexibility, strength and general health. These classes are suitable for complete beginners. Yoga mats, blocks, bricks and blankets are provided.Props are used to adapt and gain understanding of the work in the postures. Never force or strain yourself during the classes. Menstruating women should not do inverted postures, strong backbends or reverse standing postures. Those with special health conditions should consult their medical practitioner before attending classes.Please wear comfortable clothing and avoid eating a heavy meal for two hours before a class.

Declaration: I know of no reason why I should not participate in a general Yoga class. I acknowledge that any suggestions from the teacher are neither diagnostic nor prescriptive. I agree to notify the teacher of any changes to the answers above.

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