HEALTH HISTORY (FOR YOUR PARTNER)

It is important that you advise us of your medical/sexual/social history.  Some of the breathing exercises that we will be doing may alter your consciousness.   In some instances, the breathing exercises as presented may not be appropriate for you and we may want to adapt them to your specific needs.  Please consult your health care professional, if you are in doubt, as well as advising us of your condition.  Feel free to call one of us to discuss this before hand.
Please answer ALL  the questions below and fax or e-mail with the Registration Information. Your responses are confidential, so please be honest and thorough.

Check yes or no beside each of the following:

[contact-form-7 id=”242″ title=”Couple and Beginner Standard Reg Form 2″]