Medical Questionnaire for Ananda Yoga sadhana (at The Expanding Light) "*" indicates required fields Δ Name* First Last Email* Your age*Arrival Date at The Expanding Light Retreat* MM slash DD slash YYYY Departure Date* MM slash DD slash YYYY Which style(s) of yoga do you practice and how long (months and/or years) have you been practicing?*Please briefly describe your current overall health and any injuries/issues that would be helpful for the instructor to know about. This will allow the instructor to offer appropriate modifications for you during the class.*All information is confidential. Please check any of the following difficulties that apply to you and explain relevant specifics in the next question.* Back, Neck, Spinal Conditions (ex: Scoliosis) Low Bone Density (Osteopenia/Osteoporosis) Joint issues (ex: hip or knee joint replacement) Stroke High blood pressure Eye conditions (ex: glaucoma) Other None All information is confidential. Please explain the above health conditions you checked off in greater detail and with relevant dates (onset, diagnosis etc).*Are you pregnant?* Yes No If so, when is your baby due?Waiver and Release of LiabilityI understand that I must be in good physical health to participate in yoga classes offered at The Expanding Light Retreat, that my participation may cause an injury and that I should consult with my physician before I engage in yoga classes. I am taking these classes at my own risk. I waive any claim for personal injury and any other damages that I may have against The Expanding Light Retreat and any of the yoga instructors at the Expanding Light Retreat. * Yes, I accept the Waiver and Release of Liability
