Raw Elements

CLIENT INFORMATION FORM

The following information will enable your yoga instructor to offer you the safest and most appropriate yoga postures for your current level of health. All information given on this form will be treated as confidential.

    Health History:
    Please discuss any and all health concerns with your teacher and your doctor before practicing yoga.
    PLEASE TICK ANY OF THE FOLLOWING CONDITIONS THAT APPLY TO YOU.

    HYPOGLYCEMIAHEADACHESSKIN DISORDERSHEART ALIGNMENTPHILEBITISPMS SYNDROMEINFECTIOUS CONDITIONEPILEPSYPREGNANCYSLEEPLESSNESSFLU/COLD/FEVERCARPEL TUNNEL SYNCANCERT.M.J SYNDROMEVARICOSE VEINSCHRONIC/ACUTE PAINALLERGIESMENOPAUSENECK/SPINE INJURYDIGESTIVE PROBLEMSARTHRITISFIBROMYALGIAOSTEOPOROSISJOINT DISCOMFORTTHYROID CONDITIONDEPRESSIONDIZZINESSBACK PAINSCIATIC NERVE ISSUESHERNIATED DISCSHOULDER PAINHIP PROBLEMSDIABETES

    Please bring food or drink to class, if appropriate, in case of low blood sugar.

    Are you currently taking any medication or drugs?

    Agreement of Release and Waiver of Liability

    Please read the following carefully and sign below:

    • 1. I understand that the instructions given throughout the classes are intended as guidance only. I understand that while all due care will be taken by the instructor; they cannot be responsible for my improper practice at any time. To ensure that no personal injury occurs, I agree to adjust my practice according to my limitations and the decision to perform any yoga posture remains mine. I declare that I will take full responsibility for myself during the classes. I will notify my instructor before each class begins of any recent injury, illness, surgery or pregnancy.

    • 2. If I experience any discomfort during the yoga class I immediately notify the instructor. I understand that yoga should not be construed as a substitute for medical examination, diagnosis, or treatment and I should see a physician, or other qualified medical specialist for any mental or physical alignment. Because yoga should not be done under certain medical conditions, I have stated all my known medical conditions, and answered all questions honestly. I agree to keep my record updated with changes in my medical profile and understand there shall be no liability on the part of Raw Elements Healthy Lifestyle Yoga should I not do so.

    • 3. If participating in yoga classes, I recognize that yoga requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in yoga classes. I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the classes.

    • 4. I knowingly, voluntarily and expressly waive any claim I may have against Raw Elements Healthy Lifestyle Yoga for injury or damages that I may sustain. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue Raw Elements Healthy Lifestyle Yoga for any injury caused by negligence or other acts.

    Thank you for your time. We trust you will enjoy your experience with us RAW ELEMENTS

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    Thank you for your order request, please fill out your details below and we will come back to you with a total and payment request

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      www.rawelements.net.au
      Created in 2003 Raw Elements is a holistic approach to mind body and soul. Individual or yoga group sessions bookings available, for Transference healings, Foot Ionic detoxes, Holisitic counselling, Corporate yoga and Personal sessions
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      CANCELLATION POLICY & FAQS.

      BOOKINGS:

      We recommend you use our online booking system or mobile phone app to pre-book your classes up to 7 days in advance.The deadline for canceling a pre-booked class is 2 hours prior to the class start time to avoid incurring a no-show penalty - loss of one class pass OR for BODY AND MIND clients, a $15 No Show Fee.

      LATE CANCELLATION / NO SHOW POLICY:

      In the event that you can no longer attend your pre-booked class, cancellations must be made via the mobile phone booking app or online from your desktop (same login details). Class cancellations cannot be accepted via phone or email. The deadline for cancelling a pre-booked class is 2 hours prior to the class start time to avoid incurring a no-show penalty.

      LATE CANCELLATION / NO SHOW PENALTY:

      Cancellation Penalty ( deduction of 1 class visit for pass holders OR $15 fee for Direct Debit Memberships ) applies if:
      *you fail to attend your booking for any reason (no show)
      *you cancel less than 2 hours prior to the class start time (the booking system will be locked and you will not be able to cancel or remove your booking within 2 hours of class start time)
      Please note - in order for students on the waitlist to receive a notification that a space has become available cancellations can only be accepted via the mobile phone app or online. Therefore we cannot accept cancellations over the phone or via email.

      PAYMENT METHODS:

      At the studio: We accept cash, eftpos, visa, mastercard or payment via Mind Body Online Store & Mobile App Payments: We accept visa & mastercard.Direct Debit: Elect to pay via paypal or credit card.

      REFUNDS:

      Please note that all purchases are final. RAW ELEMENTS Studio does not grant refunds, transfers, or extensions for change of mind or circumstance (eg: moving out of the area).

      INJURIES & SICKNESS:

      10 pass cards are valid for 1 year from your first visit. For this reason we are unable to grant extensions, transfers or refunds due to sickness or injury.

      30 Day Intro Pass is a limited special offer, we do not grant refunds, transfer or extensions for change of mind or circumstance for this special introductory pass.

      Direct Debit Members can request to place their membership on hold for severe injuries. In most other cases we will be able to work with you in class by providing modifications.

      HEALTH CARE REBATES:

      Some health funds provide rebates for yoga classes. Some health care providers require a signed receipt with a provider number, while others only need a receipt. Check with your health care provider about what they can offer you.

      HEALTH FUND FAQS:

      My health care fund isn’t listed. Does that mean they don’t cover yoga classes?

      No. Check with your health care provider as each one has their own policy and requirements.

      Who can issue my health fund receipt?

      If your health fund requires a signed receipt, Peita Carter - Raw Elements Heathy Lifestyle - must sign it. Please contact the studio for a receipt.
      We have provider numbers for the following health funds.
      To claim, you will need a signed receipt from us with our provider number listed.