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Name
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Date of Birth
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What would you like to get from your experience with IDWellness?
Get fit
Prevent injury
Rehabilitate injury
Cope with stress
Tone and sculpt my body
Relax
Learn more about spirituality
Improve myself
Learn about my thought patterns and improve them
Other
Please use the below space to provide any relevant additional information.
Please tick any health conditions that you currently or have previously experienced.
Injuries
Surgeries or Operations (including caesarian sections)
Heart condition (please specify below if you have a pacemaker)
High or low blood pressure
Diabetes
Oedema (swollen limbs)
Breathlessness/Asthma
Anxiety
Depression
OCD
Eating problems
Long COVID
Other
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.
Have you experienced pregnancy or given birth within in the last 6 months?
We may offer relevant modifications to keep you safe, provide specifically designed exercises or look at releasing energy blockages due to the above circumstances. Please include information at your own absolute comfort and discretion. Please feel free to include information on previous pregnancies too.
Do you ever smoke or have you smoked in the past?
Yes
No
Smoker in the past
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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How did you find out about IDWellness?
Recommendation from friends/family
YourAmersham
Everything Amersham
Your Prestwood and Great Missenden
Facebook or Instagram Advert
Instagram via Hashtag or other
I did Yoga with Issi in the past
Through my company