Self History Profile

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Date
First Name
Last Name
Birth Date
Age
Race / Heritage
Gender
Height
Please select
Please select pounds kilograms
Body Weight

Birth Place
Current Living Place
From Year
To Year

No. of Brothers
No. of Sisters
Are you the eldest, youngest, etc?
Marital Status
For how long?
No. of Children
Ages

Education
Work
Hobbies
Yoga personal practice:
No. of Years
Frequency per week
Style / Description
Yoga Teaching:
No. of Years
Frequency per week (privates)
Frequency per week (group class)
No. of students per week
Ayurveda personal practice:
No. of Years
Frequency per week (self care)
Ayurveda professional:
No. of Years
Frequency per week (professional care)
Location Home Office
No. of clients per week
Personal Medical Information:
What is your current Health condition ?
Are you receiving any Healing Treatments ?
Are you taking any Supplements or Medication ?
Do you have any previous Medical History ?

Color Photo - Head View (jpg)

Color Photo - Full Body View (jpg)
When you submit this Self History Profile information it is confidential and sent only to Tedd Surman, Yoga Awareness.
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Refer a friend 'who is new to us' and they are tagged to you for life ! You don't need to do anything. On registration a new student is automatically assigned a tag. But please let us know in advance when you refer someone so that they become tagged to you. If your friend takes any Yoga Awareness trainings then we give you a 15% credit as appreciation for your referral. This referral credit will be deposited into your Yoga Awareness account which you can use anytime for your own personal Yoga and Ayurveda needs, view more >>

Self History Profile - Trainings

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