Meditation Retreat Questionnaire

What is your level of experience with meditation?
BeginnerIntermediateAdvanced

What is your level of experience with Yoga Asanas (Stretches)?
BeginnerIntermediateAdvanced

Do you have any back or neck problems?
YesNo

Do you have any joint problems?
YesNo

Do you have any heart conditions?
YesNo

Do you have any other medical conditions that would affect your practice of yoga?
YesNo

Do you have any sleeping problems?
YesNo

Do you take any medicines?
YesNo

Have you had any operations?
YesNo

Have you had any digestive problems?
YesNo

Have you had any chronic muscle pain?
YesNo

Have you had any other body pain?
YesNo

Have you had any other health issues?
YesNo

If you answered yes to any of the above questions, please provide more details and descriptions.

Please add any other relevant information.

Do you have any dietary restrictions? If so, please describe.

Share This