Confidential Questionnaire

Before you commence your first session with Leonie, please fill in the health and activity  questionnaire below.
Any information given in the questionnaire will be confidential, equally you don't have to tell me about any conditions, but it would be helpful to ensure you practise safely. 


Please don't navigate away from the online form while filling in or the form will clear.


If you have already completed the full form previously and nothing has changed, just fill out your name and contact details and accept the T&Cs.

 

 
Name *
Name
What is your address?
What is your address?
What is your date of birth?
What is your date of birth?
Have you practiced Qigong or Yoga before? *
Do you have any pain or injuries in the following areas?
Do you suffer from any of the following?
Females - Are you pregnant? Please let me know if you become pregnant and you wish to keep attending yoga classes
Would you like your email address added to our mailing list to receive our newsletter and free things from time to time?
We respect your privacy
SAFETY FIRST... Work within YOUR OWN ability – we are all different, make the class your personal practice. You should not experience any pain, especially in the knee or lower back region – it’s a signal to ease off. Let me know if you have any new injuries or conditions, or if you become pregnant. Never strain or force yourself (body or breath). Ease back to your own comfort range. If you are unsure of anything, just ask Leonie. Finally, trust yourself, listen to your body and ENJOY! *
Terms and Conditions *
Find the T&C's here http://www.leoniebeck.com/terms-conditions