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  Registratrion Form  
 
 
Dr. MALA SINGH
Ph.D. (Philosophy)
Yoga Shiromani, Shivananda International Yoga Vedanta Centre


Please fill up the following questionnaire:

NAME :
AGE :
SEX :
QUALIFICATION :
PROFESSION :
ADDRESS :
PHONE :
Email :
     
   
Do you suffer from:
Diabetes Yes No
Asthma Yes No
High Blood Pressure Yes No
Low Blood pressure Yes No
Arthritis Yes No
Migraine Yes No
         
 
Please give details of family history related to any of the above.
 
Have you had any serious injury/surgery in the past?
 
Any other medical detail, which you wish to give.
 
What motivated you to join Yoga?
 
What do you wish to achieve through Yoga?
 
 

 

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