Health Questionaire

Please note that this questionnaire is strictly confidential and information collected is strictly in accordance the Privacy Policy Kate adheres to in her therapeutic work.

This data is only collected for the purpose of your wellbeing on the retreat and will be discarded after.

Name *
Do you suffer from any condition that may affect your physical ability to spend the best part of a day sitting? *
If so please detail any special requirements or adaptations that can be made to help you.
Have you experienced or been diagnosed with any mental health issues (including anxiety/depression) at any point? *
Do you wish to engage in a gentle "yin" yoga practice *
Please know that you can also decide on the day but this just gives us an idea of numbers
Have you experienced any major trauma in your personal life over the last 2 years? (eg Death/Divorce/Major Injury) *
Is there anything else you feel it would be helpful for Kate or Ursula to know?
I understand that Kate or Ursula may contact me to discuss the above prior to the retreat. *
For you to attend the retreat day it is important that we are completely confident that it won't jeopardise your emotional or physical wellbeing. We'd appreciate your consent to get in touch prior to the retreat if necessary. If so it will be Kate that contacts you about emotional and physical issues affecting the mindfulness and Ursula about physical issues that may affect the yoga.
My preferred contact method is *