Please contact Wendy to book your session before making your payment. Online payment is preferred but alternatives can be arranged. Payment details will be supplied. Many thanks

Your name:

Home Address:

Telephone:

Mobile:

Email:

Emergency contact:

GP and practice:

PRE-SESSION QUESTIONNAIRE

1) Where did you find out about the Alexander Technique with Wendy Broad?

2) Please give details of any previous Alexander Technique courses or lessons you have attended:

3) Do you have any physical illness or limitation(s) that may make sitting, lying or movement difficult for you? If yes, please provide details, thanks.

4) Do you have any visual or hearing impairment which could make participating in Alexander Technique lessons difficult for you? If yes, please provide details, thanks.

5) Please outline any health conditions, including areas of pain or discomfort.

6) Please indicate briefly what has drawn you to Alexander Technique lessons:

CANCELLATION POLICY

Please check the cancellation policy on the website.

Participant's Signature (please write your name here):

Date:

Data Protection Policy and Privacy Policy

Your data will be handled according to my Data Protection and Privacy Policy.

The health information is collected for my insurance purposes and to enable us to respond to your needs and assess for class suitability. Your personal contact details may be used by us to contact you about events and offers, if you give us permission to do so. Your contact details are not shared with third parties. A paper copy of your information is held in a locked cabinet for a period of 5 years as a condition of my insurance policy. After this time your information will be destroyed.