QUESTIONNAIRE

Thank you for contacting me and I look forward to interacting further with you. In order to ensure our next discussion is more meaningful for you, I would appreciate it if you would complete and submit the below questionnaire. As soon as I receive it back from you I will make contact with you.

Name *

Email *

Have you done any yoga in the last few years? *

If yes, please advise if you are beginner, intermediate or advanced.

Beginner
Intermediate
Advanced

Are you currently exercising? *

If yes, please state what that is.

Do you have any health concerns? (ie. Diabetes, cancer etc.) *

Are you currently on any medication? *

Are you struggling with your weight either under or over weight? *

No
Underweight
Overweight

Have you been sick in the last 6 months? *

If yes, please state the illness.

Are you currently suffering from an injury and have you had any injuries in the past? *

If yes, please state the injury.

How do you feel both emotionally and mentally at the moment? *

How does your body feel? (ie. sluggish, stiff, exhausted, strong) *

Do you enjoy a massage? *

Have you been for a massage in the last 6 months? *

If yes, please indicate if you prefer light, medium or hard massage.

Do you enjoy essential oils and are there perhaps any that you are aware of that you are allergic to? *

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