Yoga Consent Form With Victoria Rose Name * Client's Email Date of Birth Month Day Year Have you done yoga before? Yes No If yes, can you please provide more details? e.g. Style of Yoga, experience level. Do you have any physical disability or any health issues/conditions that I should be aware of? * Yes No If yes, please provide more details. Do you have any of the following? Lower Back pain Upper Back pain Shoulder pain Numbness to any part of the body Muscular pain Neck injury Seizures Knee surgeries Allergies Surgery Are you/could you be pregnant? Yes No Consent Agreement Type your full name to confirm consent * By typing your name above, you confirm you have read and agree to this consent form. Date Signed * Month Day Year Submit
