Skip to content
Home
Birth Doula
Yoga
Pregnancy Yoga
Mums & Bubs Yoga
Yoga Retreat Day
Yoga Therapy & Private Yoga
Massage
Thai Yoga Massage
Pregnancy Massage
Thai Foot Reflexology
Hens Parties and Girls Weekends
Gift Vouchers
Training
Thai Yoga Massage Level 1
Thai Yoga Massage Level 2
Advanced Thai Yoga Massage Techniques
Thai Yoga Massage for Pregnancy
Pregnancy Yoga Teacher Training
Couples Thai Massage Training
Thai Yoga Massage Taster Workshop
Thai Foot Reflexology Training
About
Timetable
Shop
Contact
Menu
Home
Birth Doula
Yoga
Pregnancy Yoga
Mums & Bubs Yoga
Yoga Retreat Day
Yoga Therapy & Private Yoga
Massage
Thai Yoga Massage
Pregnancy Massage
Thai Foot Reflexology
Hens Parties and Girls Weekends
Gift Vouchers
Training
Thai Yoga Massage Level 1
Thai Yoga Massage Level 2
Advanced Thai Yoga Massage Techniques
Thai Yoga Massage for Pregnancy
Pregnancy Yoga Teacher Training
Couples Thai Massage Training
Thai Yoga Massage Taster Workshop
Thai Foot Reflexology Training
About
Timetable
Shop
Contact
$
0.00
0
Cart
Yoga Therapy Registrations
Expression of interest for joining
Small Group Yoga Therapy sessions (5 week block); or
Individual (Private) sessions (2-3)
First name
Last name
Email
Phone number
Address
Occupation
Date of birth
MEDICAL HISTORY
Have you had any major surgery? If so what & when?
Please give details of any injuries, fractures, dislocations and how long ago.
Do you have any of the following?
High or low blood pressure
Heart problems
Asthma
Arthritis
Carpal Tunnel
Neck problems
Back problems (including Pubic Symphisis pain and/or Sacroiliac pain)
Abdominal separation
Pelvic floor weakness
Other (please specify below)
Other
Which health concerns are you looking to manage using yoga therapy?
Chronic pain (please specify location under Other)
Back pain
Stress
Anxiety & panic disorder
Depression
Trauma recovery
Asthma
Addiction/Eating Disorder
Poor sleep
Other (please specify below)
Other
YOGA EXPERIENCE
Have you practiced yoga before? If so, for how long and where / what kind?
What is it you would like to get out of yoga?
Relaxation
Stress Management
Flexibility
Strength
Relief from back or neck pain
Other (please specify below)
Other:
How did you find out about Dani Mondahl?
AGREEMENT
I understand that the instructions given throughout classes are intended only as a guidance. It is therefore my responsibility to adjust my practice according to my limitation to ensure no personal injury occurs; and inform the teacher before the class of any recent change to my physical condition.
I hereby declare that by submitting this form I release Dani Mondahl of any responsibility for any injury sustained and that I will take full responsibility for myself during the yoga classes.
I understand that once I am accepted to participate in the free practicum sessions that I commit to attending all agreed to sessions/appointments and there will be additional hardcopy consent forms and questionnaires to complete beforehand.
Send
