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Thanks for purchasing your Yoga Retreat with Lucia Yoga

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Health Questionnaire

Name *

Enter your date of birth in “dd-mm-yyyy” format.
For example, if your birthday is 3rd May, 1980, enter 03-05-1980. *

Email *

Your Retreat Date

Your Favourite Band / Song

Facebook

Have you done Yoga before? Yes/No.
If yes, what type(s) and for how long?

Do you practice physical exercise? What kind? and for how long?

Do any of these health conditions apply to you?

Do you have any other conditions which affect your mobility or are likely to cause
you concern when doing Yoga?

If Yes, give details:

Which aspects of Yoga most interest you? Please tick as many as you wish:
Physical postures (asanas)RelaxationChanting & HealingBreathwork (pranayama)MeditationAshtangaVinyasaHathaNutrition

Do you have any food intolerance? Please detail any type of food that can not take.

Accomodation Preferred (We do not guaranteed shared room for solo bookings)
Single OccupancyDouble Room, SharedTwin Room, Shared

How did you first hear about this yoga retreat? (Details are appreciated) *

I take full responsibility for my health during the yoga classes, including any injuries.
I will inform my yoga teacher of any medical changes.

Thank you for filling out the questions!

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