A. General Information
Name(In Capital Letters)
Date of Birth:
Age:
Marital Status:
Gender: Male Female
Residential Address:
Education:
Profession:
Phone(R)
Phone(O)
Mobile
Email Id
Emergency Contact:
Suitable Time to Contact
B. Health Issues
(Kindly mention each detail honestly. This information will help us to plan your lifestyle)
ARE YOU TAKING ANY MEDICINE? (IF YES, KINDLY MENTION DETAILS)
Any PAST Illness, If yes Please Mention
(KINDLY EMAIL COPY OF YOUR RECENT MEDICAL REPORTS)
Any PRESENT Illness, If yes Please Mention
(KINDLY EMAIL COPY OF YOUR RECENT MEDICAL REPORTS)
Any History Of illness in The Family (HEREDITARY), If Yes Please Mention
Weight(In Kg At Present)
Height(In Inches At Present)
Waist(In Inches At Present)
Thigh(In Inches At Present)
Lifestyle
General Food Habbit (Veg/Non-Veg/Tea/Coffee/Smoking/Drinks/Gutkha/Sweets)
Favourite Food
Rising Time
Sleeping Time
Stool Time & Type
How do you spend your Time (HOBBIES AND GENERAL HABITS)
What is the Philosophy of your Life
Have you ever joined Yoga Program, if YES Where?
How did you know About Us
Purpose Of Joining Yoga Programme
Any Other Information
Recommended Yoga Programme by Yoga Expert
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