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Consultation

Yoga Consultation Form · Before You Arrive

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Before You Arrive

Yoga Consultation Form

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This short consultation helps our teachers care for you safely and personally. Please complete it after your seat is confirmed — all health information is kept strictly confidential.

About You

Full name

Email

Contact number

Occupation

Program / package

Height

Weight

Do you smoke?

Non-smokerSmoker

Your Health

Medications you are currently taking

Supplements you are currently taking

Have you experienced any of the following? (tick all that apply)

Blood clotting disordersCirculatory or heart problemsBack or neck discomfortAny accidental injuryMuscle crampingDigestive problemsRespiratory problemsUlcersDiabetesJoint painHigh blood pressureLow blood pressureHeadachesPast surgeriesVaricose veinsFainting spells or dizzinessNumbness or tinglingInsomnia

Allergies, if any

Please explain any conditions ticked above

If you are a woman — are you pregnant? If yes, how many months?

Lifestyle

Do you engage in physical activity? Which, and how often?

Do you sit for long hours at a desk, computer or driving?

Any repetitive movement or sustained position in your work, sport or hobby?

Recent stress level

LowModerateHigh

Appetite

LowModerateHigh

Bowel movements

LowModerateHigh

Sleep quality

AverageGoodExcellent

Daily water intake

Under 1 litre1–2 litresOver 2 litres

Flexibility

TightAverageGoodExcellent

How does stress affect you? (tick all that apply)

Muscle tensionAnxietyInsomniaIrritabilityOther:

Your Yoga Journey

What is the primary reason or goal for your yoga practice?

Have you practised āsana and prāṇāyāma before? Which style?

Are you familiar with any of these yogic concepts / philosophy? (tick all that apply)

ChakrasKundaliniPranasAshtangaMantraTantraYantraHathaRaja YogaKriyasNadaPatanjali

Your thoughts or perception of yoga, if you have practised before

Liability & Disclaimer

Yoga practice involves physical activity and is undertaken at your own risk. Practices are adapted where possible, but Rishikesh Yoga School is not a medical facility, and to the extent permitted by law is not liable for personal injury, loss or damage to belongings, or costs arising from events beyond its control. You must hold valid travel and medical insurance for your full stay. Please read our full School Policies and Refund & Cancellation Policy.

I confirm the information above is a complete and true account of my medical history, I have been advised of safety precautions, and I accept the school's policies including the liability terms above.

Full name (as signature)

Date

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Occasional letters from the ashram — new course dates, articles and yogic wisdom. No noise.

Email address

Traditional Hatha Yoga by the sacred Ganga — teacher training, retreats and daily practice in Rishikesh, India.

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ॐ सर्वे भवन्तु सुखिनः सर्वे सन्तु निरामयाः

May all beings be happy, may all beings be free from illness

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