Health Questionnaire

India Yoga & Pilates Retreat 2026
Your comfort, health and wellbeing matter to us. Please share any needs that will help us plan safe and supportive sessions, meals and excursions.

India Retreat Health & Wellbeing Questionnaire

Please take a moment to fill out the form.

Full Name

Date of Birth

Address

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Enter manually

Select an Address (Hint: start typing first line of your address)

Address (include post code)

Emergency contact 1: name, relationship, phone number with international dialling code, and best way to reach them during the retreat

Emergency contact 2 (optional): name, relationship, phone number with international dialling code, and best way to reach them

1. Do you have any medical condition, injury or ongoing health concern that may affect travel, yoga, Pilates, walking or daily wellbeing during the retreat?

Yes

If yes, what adjustments, precautions or support would help? Please share only relevant details.

2. Have you recently been ill, had surgery or been hospitalised, or received medical advice limiting travel or physical activity?

Yes

If yes, please give details

3. Do you have any food, medication or environmental allergies, food intolerances or dietary requirements we should know about for the retreat in India?

Yes

please give details

4. Would you like us to know about any emotional wellbeing needs, anxiety or support that could help you feel comfortable during the retreat?

Yes

please give details

5. Do you have pain, mobility or balance limitations, or difficulty with stairs, uneven ground or prolonged walking?

Yes

please give details

6. Please note any medication or health supplies you need to manage during the retreat, any travel insurance or medical assistance arrangements we should know about, and any other wellbeing needs. You may ask to discuss this privately.

Your Signature

Mobile number

I explicitly consent to Balance & Beyond using the health, allergy and dietary information I provide to plan my India retreat participation and, when needed, sharing relevant details with retreat staff, catering providers or medical professionals in India. I can withdraw this consent by emailing support@balanceandbeyond.co.uk.Read our Privacy Policy

Participant Health & Safety Acknowledgement

I confirm that the information I have provided is accurate and complete to the best of my knowledge.

I understand that the retreat includes yoga, Pilates, meditation, travel, sightseeing and optional outdoor activities, which may involve physical exertion and inherent risks.

I agree to listen to my body, practise within my own abilities, follow reasonable safety instructions, and inform the retreat instructor of any health changes or concerns that may affect my participation. I may modify, pause or opt out of any activity, and I should seek medical advice if I am unsure whether an activity is suitable for me.

I am responsible for carrying and managing my personal medication unless specific support arrangements have been agreed in advance. Yoga and wellbeing guidance is not a substitute for professional medical advice or treatment.

Nothing in this acknowledgement excludes or restricts any legal rights or liabilities that cannot lawfully be excluded.

Thanks for submitting!