Yoga Health Questionnaire 1. Personal Information Full Name: Email: Contact Number: Age: Gender: FemaleMale Occupation: 2. General Health Information Do you have any pre-existing health conditions (e.g., asthma, heart disease, arthritis, etc.)? Are you currently under the care of a healthcare provider for any medical issues? Have you had any surgeries in the past? If so, when and what was the procedure? Do you have any allergies (e.g., food, medication, environmental)? Are you currently taking any medications? If yes, please list them. 3. Lifestyle How would you describe your current level of physical activity (Sedentary, Lightly Active, Moderately Active, Very Active)? What types of physical activity or exercise do you engage in regularly (e.g., running, strength training, cycling)? Do you have a sedentary job or lifestyle (e.g., sitting at a desk for long periods)? 4. Yoga Experience Have you practiced yoga before? If yes, for how long and how often? What styles of yoga have you practiced (e.g., Hatha, Vinyasa, Kundalini, Ashtanga)? What do you hope to achieve from practicing yoga (e.g., stress relief, flexibility, strength, mindfulness)? 5. Current Symptoms or Concerns Do you experience any chronic pain or discomfort (e.g., back pain, joint pain, headaches)? Are there any specific areas of your body where you feel tension or tightness (e.g., neck, shoulders, hips)? Do you have any difficulty with movement (e.g., limited range of motion, balance issues)? 6. Mental and Emotional Well-Being Do you experience high levels of stress or anxiety regularly? Have you ever been diagnosed with any mental health conditions (e.g., depression, anxiety, PTSD)? Do you find it difficult to relax or clear your mind? Are you currently undergoing therapy or counseling? 7. Sleep and Rest How many hours of sleep do you typically get each night? Do you have trouble falling asleep or staying asleep? Do you wake up feeling rested? 8. Dietary Habits Do you follow a particular diet (e.g., vegetarian, vegan, low-carb)? Are there any foods that you avoid for health or ethical reasons? Do you drink alcohol, caffeinated beverages, or smoke? 9. Injuries or Limitations Are there any injuries or physical limitations that affect your ability to practice yoga (e.g., shoulder injury, knee pain)? Do you have any mobility issues (e.g., difficulty getting up from the floor, limited flexibility)? 10. Goals and Expectations What are your primary goals for practicing yoga (e.g., improving flexibility, gaining strength, stress relief)? Do you have any specific expectations from your yoga instructor or practice?
