Satyadhara Yogalife Ashram, Choral, Indore

 

YOGA THERAPY QUESTIONNAIRE FORM

General Information

    • Contact Informatin

    • Physical Detail

    • Medical History

    About Parents (Have they been suffering with)

    Section

    Cardiac Problem

    • Low or High Blood Pressure

    • Asthma

    • Diabetes

    • Cancer

    • Hypo or Hyper Thyroidism

    • Cancer

    • Hypo or Hyper Thyroidism

    • Adrenal Fatigue

    • Kidney failure

    • Migraines

    • Digestive Disorders

    • Any other major health problem

    • About You

    Previous Illness (in last 10 years but doesn’t exist now)

    • Any major surgery

    • Any accident

    • Current illness

    • List of any current Medications, give the names of medicines below

    • Lifestyle

    • Eating Habits

    • Main Concerns for Taking Yoga Therapy