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Yoga Health Assessment
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Name
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Please fill in, with details where relevant
Do you have any current health conditions?
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Heart/lung issues
Diabetes
Auto-immune condition
Anxiety
Depression
High blood pressure
Asthma
No health issues
If Other please specify:
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What is your age?
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Less than 13
13-18
19-25
26-35
36-50
50-60
60-70
Over 70
Do you have any current issues with reproductive health?
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Currently pregnant - no health issues
Pregnant with some health issues
Recently gave birth
Recently miscarried or terminated pregnancy
Currently menopausal with some symptoms
Symptoms from menstrual cycle
Prostate issues
No health issues
Any other comments or health issues?
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Date:
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