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Yogabellies at Constant Health Yoga Booking Form
Please complete this form to book onto your sessions. Once received, Jacqui will email you confirmation and payment details.
Name
First
Last
Phone
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Email
Please select class
YogaBellies Pregnancy Class Mondays 6:30pm
Luna by YogaBellies Class 8:00pm
Please advise if you are experiencing any of the following
Pelvic Girdle Pain
High blood pressure
Low blood pressure
Asthma
Postnatal Depression
Sciatica
Anemia
Carpel tunnel syndrome
Diabetes
Epilepsy
MS
Please advise of any other relevant information (including medical not listed above)
Please advise of any medication
Where did you hear about Yogabellies at Constant Health
Word of mouth
Facebook
Instagram
Google
Health Professional
Other (please state below)
Other (please state here)
Yogabellies at Constant Health, may from time to time, like to share your comments and/or use a photograph which may be taken within the class, and use as part of their marketing on social media.
With your approval below, you will be giving your authorisation to use either the photograph/s and/or your testimonial.
Please tick the box/es, to indicate your permission
I give my consent to us my testimonals
I give my consent to use photos
I give my consent to both the use of testimonals and photos
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