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Doctor and Patient

Health Questionnaire

We are delighted to have you signed up for the upcoming Yoga retreat. Now, it's time to get real: Your downward dog depends on it 😊

My Health Questionnaire

Please take a moment to fill out the form.

1. Do you have any injuries or chronic conditions that may affect your ability to participate in yoga classes?
2. Have you experienced any recent illness or surgery?
3. Are you allergic to any foods, medications, or environmental factors?
4. Do you have any dietary restrictions or preferences?
5. Do you have any mental health concerns or conditions?
6. Are you currently experiencing any physical pain or discomfort?

I acknowledge that I have completed this health questionnaire to the best of my knowledge and understand that the information provided will be used by the yoga instructor and staff to ensure my safety and well-being during the retreat.


I understand that participation in yoga classes and related activities may involve some risk of personal injury. I voluntarily assume all risks and responsibilities associated with my participation in this retreat, and hereby release and hold harmless the yoga instructor, staff, and any affiliated parties from any and all claims, actions, or damages arising from my participation in this retreat.


I also acknowledge that the yoga instructor and staff are not licensed medical professionals, and their guidance should not be construed as medical advice. I am solely responsible for seeking appropriate medical advice and treatment as needed.


By signing this health questionnaire, I certify that I have read and understand this disclaimer, and agree to abide by its terms and conditions.

Thanks for submitting!

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