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  • Health Form

YOU & YOUR HEALTH

    Health Form for Yoga/ Bodywork/ Therapies

    Before we work together, I need to know more about you, your current and past health. All of this information is confidential, if you prefer to email me your information, get in touch. 

    1. Your contact information
    2. Your emergency contact (friend/family member etc)

    3. General information about you
    4. Your general health
    5. If you have a vulva, please answer the following questions. People with a penis, you can go directly to the next section...
    6. Lifestyle questions
    7. The legal bit
    By submitting this form you acknowledge that you have shared information to the best of your knowledge. You agree to take responsibility for yourself during each session with Charlotte Speller. You agree for your details to be used by Charlotte Speller for marketing and communication purposes only. Your personal information is confidential and will never be shared with any third parties without your consent!

    During yoga classes from time to time, I may record or take photos for education or marketing purposes. If for any reason you do not consent to this, please get in touch. 

    I am really looking forward to working with you soon! 
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