Jackie Lee
07941 468 576
Email Jackie
Jackie Lee
07941 468 576

Yoga Classes in Enfield and N21

Health Questionnaire Form

    Your Details

    Health Conditions

    Have you experienced any of the following (please tick those that apply)?

    If ‘Yes’ please give details below:

    Joint problems
    Back or neck problems
    Heart problems
    Chest problems
    Recent surgery
    Respiratory problems
    High or low blood pressure

    Current or recent pregnancy
    Carpal tunnel
    Ear or eye disorders

    You should seek the approval of your doctor before taking part

    Your Yoga Experience

    If you have previously practised Yoga, please indicate for how long and which style:


    Privacy Statement & Data Protection

    In accordance with the Data Protection Act 2018 & the General Data Protection Regulation (GDPR), the information that you have provided on this form to Jackie’s Yoga North LondonJ will be used in the following ways. Please tick the box below to give your permission:

    • To store it securely for the purpose of providing Yoga classes, courses and workshops either electronically or in paper form

    • To use it for the purpose of running our Yoga classes, courses or workshops

    • To communicate with you as a customer of Jackie’s Yoga North London by telephone or email about your Yoga classes, courses or workshops

    • To share with employees/representatives of Jackie’s Yoga North London

    I consent to my data being used only for the purpose of delivering Yoga Classes, courses and workshops as detailed above:
    Please tick the box to confirm the above*:

    We will not disclose your data to anyone else without your prior consent.

    Please be advised you can request that your data be removed from stored records within 28 days by contacting Jackie’s Yoga North London by email.

    You have a right to complain to the ICO if you believe there is a problem with Jackie’s Yoga North Londons handling of your data.

    Please also see our Privacy Policy and the Terms & Conditions for Online Classes for more information.


    I have read, understood and accepted these terms and completed this questionnaire fully.

    I take responsibility for my health in class and will inform the teacher of any changes in my medical condition.

    Please tick the box to confirm the above*:

    * Indicates required field

    Your Privacy

    We do not store your personal information for any other purpose than that of our own use. Our website is SSL protected meaning that when you contact us through the website, all your details are encrypted before being transmitted to us.

    Please see our Privacy and Cookies Policy page for more details.