Health Assessment First Name* Last Name* Occupation* Retreat Date* Car RegistrationPlease provide if you plan to park your car onsite. Blood Pressure*NormalLow Blood PressureHigh Blood PressureI don't know (we suggest you check with your GP prior to your retreat with us)Are you taking any medication, supplements or other remedies?*YesNoPlease provide details belowDo you have any pre existing medical conditions?*YesNoPlease provide details belowDo you have any known allergies?*YesNoPlease provide details below Food IntolerancesPlease provide details of all known food intolerances Do you have any others health concerns?*YesNoPlease provide details belowWhich of the below ways of eating do you most closely align to? Raw Vegan Vegetarian Paleo Low GI None of the above What else would you like to address during your time with us and is there anything else you feel we should know?What are your main aims and intentions for your retreat?*Yoga Level* Complete Beginner (no previous yoga experience) Beginner (a little yoga experience) Intermediate Advanced Yogi Yoga Teacher I confirm that;* the information I have provided is, to the best of my knowledge true and accurate. I understand that;* if there are any changes to my mental or physical health that I will inform Platinum Healing immediately I confirm and agree that;* the information I have provided above will be shared with the appropriate team members I confirm that;*https://www.platinum-healing.com/welcome/terms-and-conditions/ I have read, understood and agree to the Terms and Conditions Signature (please type your full name below)* Date of Signature* MM slash DD slash YYYY Δ