Summary: Prenatal Yoga Student Information Sheet
For more information call 800-926-8273 or visit health.ucsd.edu.
Please print, fill out, and bring to the first class.
Name (please print) _____________________________ Email___________________
Today's Date____________ # of Weeks Pregnant_______ Due Date____________
1) How has your pregnancy been so far? Any concerns I should know about? Please explain.
2) Do you have other children? ______ If yes, were the other pregnancies healthy? ___ Did you
deliver vaginally? ___Did you deliver un-medicated? _____
3) Do you have a history of miscarriage of infertility? _____If yes, please explain.
4) Do you have a job that requires extended periods of sitting? Do you have a job where you are
on your feet a lot? Please explain.
5) Did you practice yoga before this pregnancy? ____ If yes, please explain how often, where and
what style you enjoyed.
6) Before pregnancy, what type of physical exercise did you do? How often did you exercise?
7) Where are you giving birth?
8) On a scale from 1-10, how important is it for you to have a natural birth? ___
1= No way!!!
5= I'll give it my best, but I'm definitely open to epidural.
10= No Drugs!!!
9) Occasionally I will come by and adjust or massage my students. Are you comfortable with