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Yoga - Questionnaire/Waiver

Please fill out the following form to help us understand your physical condition.

First Name

Is this your first birth?

Last Name

Estimated Due Date

Have you discussed a prenatal yoga practice with your care provider? *

No

Yes

How are you feeling?

Are you currently suffering from a medical condition, illness, or injury? *

No

Yes

Initials

Today's Date

By initialing, I consent to

Thanks for submitting!

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