Namaste Studios

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First Name

Last Name

Please check box if any of the folowing apply

History of heart disease, chest pain or stroke

High blood pressure (140/90 or over on several occasions)

Any chronic illness or condition

Difficulty with physical exercise

Advice from physician not to exercise

Recent surgery (within the last 3 months)

History of breathing or lung problems

Muscle, joint, or back disorder, or any previous injury still affecting you

Diabetes or thyroid condition

Pregnant

Cigarette smoking habit

Increased blood cholesterol (over 200 total)

History of heart disease in immediate family

Hernia, or any condition that may be aggravated by exercise