Pregnancy yoga booking form
Please type in your name (*)

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Home telephone (*)

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Work telephone

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Date of birth

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Which class do you prefer? (*)

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How did you hear about this class?

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How do you hope to benefit from this class?

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Please give details of any of the above which you have ticked, or any other health issues.

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Previous miscarriages?

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Previous births? if so please give ages of children.

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Thank you for completing the form. The information you have given is confidential and will help us to gear the classes to your needs.

Submit form and continue to payment options
Please type in your address (*)

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Mobile telephone

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Email address

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Baby's due date (*)


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What is your ideal start date?


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Have you studied yoga before?If so, for how long, how recently, what style etc?

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During this pregnancy, have you experienced any of the following?























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Prior to this pregnancy, have you suffered any injury or undergone any surgery (e.g. caesarean, knee surgery) that may have some bearing on your yoga practice?

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Please give details

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Are you taking any form of medication that may have a bearing on your yoga practice? If so, please give details.

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Pregnancy yoga (6weeks)