Sai Geetha Ashram |Yoga Teacher Training Program

Yoga Teacher Training Program

Male Female

Date

Enter Address:

E-Mail Address

Phone Number

Birth Star :

Wt:

Ht:

Pan / Adhaar No:

Contact Details - Country Code:

Education

Occupation

Job: Part time / Full time

Father’s/Spouse Name

No. of Children

Passport No

Visa Details (Expiry Date, Type)

Mode of Payment:

Marital Status

Yes No

Single Parent

Yes No

Divorced

Yes No

Questionnaire:

Please be accurate in answering, so that we can plan your program better. Questions are asked to understand your physical, mental wellness and lifestyle habits.

I. Personal Details:

Staying Alone:

Yes No

If No., No. of people at home :

II. Lifestyle & Dietary Habits:

Diet

Veg Non-veg

Vegan or Any other :

A typical sample menu which you follow:

Early Morning:

Breakfast:

Lunch:

Evening:

Dinner:

TEA/COFFEE

Yes No

CIGARETTES/TOBACCO

Yes No

ALCOHOL:

Yes No

SLEEP PATTERN

Sleep late almost every night Sleeps late occasionally Regular 8 hours sleep Regular but less than 8 hours sleep Insomnia (Sleeplessness) Disturbed Sleep

EXERCISE:

Intense exercise every day Moderate exercise every day Exercise Occasionally

Type of exercise you perform :

Duration of exercise :

Are you a Meditation practioner? Yes/No :

If Yes, Mention what type of practice is it:

Do you practise any Healing Therapies?:

III. HEALTH HISTORY (Try to fill in to the best of your knowledge)

Status of Covid Vaccination 1st

Status of Covid Vaccination 2nd

Booster Dose:

Any history of Post Vaccination:

Are you Covid Positive?

What was the Covid prognosis

Was it Severe or Mild?

Are you under medication

Allopathy :

Homeopathy:

Ayurveda :

Supplements :

Any Family History:

Mother :

Father :

Siblings :

Others :

Your Past Medical History - Any specific health issues affected during the below Age group:

Baby – 10 :

10-20 :

20-30 :

30-40 :

40-50 :

50-60 :

Any Present Health issues:

Allergic to any:

Medication Fruits Vegs Food Dust etc.

Do specify:

Undergone any medical surgeries:

Year:

Any recent or old Injuries / fractures:

Purpose of Joining:

I agree and claim that the above information given is true to the best of my knowledge.