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Date of Birth
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Name
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Have you practiced yoga before? (If yes, please give details)
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What would you like to get from your experience with IDWellness?
Please use the below space to provide any relevant additional information.
Please tick any health conditions that you currently or have previously experienced.
If you ticked any of the above, please use the space below for further details if applicable.
Are you currently taking any medications? Please give information in the space below.
During our services, to allow further relaxation, oils and other substances (such as Sage, Palo Santo and other plants (all legal) may secreted or into the surrounding air, via diffuser, burning them or applied on your skin. Some of these may contain traces of nuts and other allergy inducing substances. Please state if you have any allergies, intolerances, or skin conditions we need to be aware of or any objections to the use of oils and other substances used in this way.
Do you ever smoke or have you smoked in the past?
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Smoked in the past
Do you or have you experienced Pre-eclampsia?
Yes
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Do you or have you experienced Oedema (swollen limbs)?
Yes
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Is this your first pregnancy?
Yes
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Have you experienced a caesarian section(s).
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If yes, please state how long ago and other relevant information you feel comfortable to share.
Please share any alternate birthing procedures or postnatal information you feel comfortable to disclose.
For example; pelvic floor health, separation (Diastasis Recti) and so on if known.
Have you had IVF treatment?
Yes
No
Have you ever had a miscarriage?
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No
Please feel free to give more information relevant to any of the above.
It is your responsibility to submit the correct information this form is and to let us know if any of the information submitted changes or no longer applies.
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I agree to the IDWellness Waiver of Liability for all IDWellness Services and Disclaimers of Warranties and Limitations on Liability for all IDWellness Services (Accessible at www.id-wellness.com/termsofservice)
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By using our services you agree to to our Terms and Conditions and Privacy Policy, including GDPR. (Terms of Service accessible at www.id-wellness/termsofservice and Privacy Policy, including GDPR available at www.id-wellness.com/privacypolicy
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