Health Questionnaire Writing Retreat Bali Information for Yoga, movement and food allergies Go backYour message has been sent Name(required) Warning Email(required) Warning Doctor’s name, address and telephone(required) Warning Do you have any severe food allergies or medically diagnosed food intolerances?(required) Yes No Warning If yes, please provide details. Warning Are you currently taking any medicines or receiving any medical treatment?(required) Yes No Warning If yes, please provide details. Warning Do you suffer from pulled ligaments or tendons?(required) Yes No Warning If yes, please provide details. Warning How often do you practice Yoga? Never Tried Once Sometimes Regular Practice Warning How long have you practiced Yoga?(required) Never 6 months Less than 2 years Less than 5 years More than 5 years Warning Have you ever been on a Yoga or writing retreat of any kind before?(required) Yes No Warning If yes, please provide details. Warning Is there anything else we should know? Yes No Warning If yes, please provide details. Warning Thank you for completing the questionnaire. Now please press submit to send. Warning. Submit Δ Share this: Click to share on X (Opens in new window) X Click to share on Facebook (Opens in new window) Facebook Like Loading...
Writing Retreat Bali 