Lisa Fabry Nutrition & Yoga Therapy
Date of birth
Phone number (inc. country and area code)
No and ages of children
Do you have any current medically diagnosed conditions or injuries?
How would you describe your health?
What are your three main health/wellness goals?
Please list all medication you take, including prescribed drugs, over-the-counter medicines eg Panadol, and supplements
Have you ever experienced a hypersensitivity reaction to any medication or remedy?
Do you have any known allergies or sensitivities?
Please describe your current level of physical activity (type of exercise, frequency, duration)
Please describe any previous yoga experience (style, length of time practised, how recent?)
What do you hope to get out of this course?
Is there anything else you would like to add?