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Health Questionnaire
We look forward to seeing you at Lucia Yoga Retreats!
Please let us know
Health Questionnaire
We look forward to seeing you at Lucia Yoga Retreats!
Tell us about yourself
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Full Name
*
Email
*
Phone
*
Birthday
*
Retreat Date
*
Have you done Yoga before? Types/How long
Exercise? What kind? For how long?
Do any of these health conditions apply to you?
High blood pressure
Low blood pressure/fainting
Arthritis
Diabetes
Epilepsy
Heart problems
Asthma
Depression
Detached retina/other eye problems
Recent fractures/sprains
Recent operations
Back problems
Knee problems
Neck problems
Recent pregnancies
Pregnant now
Do you have any other conditions which affect your mobility or are likely to cause you concern when doing Yoga?
Do you have any food intolerance? Please detail any type of food that can not take.
Accomodation Preferred
*
Single Occupancy
Double Room, Shared bed
Twin Room, Two single beds
This is preferred accommodation, we can't guarantee it. Please contact us for confirmation.
Sharing with
Please note: If you would like double occupancy and do not have a roommate, we will make efforts to pair you with another participant. However, if there is not another student to pair you with, you will have a single occupancy room at that rate. For solo bookings we do not guaranteed a shared room.
How did you first hear about this yoga retreat?
*
Details are appreciated!
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