Medical Have you had any major surgery in the last six months? * Incase you are retaking our retreat, please provide the month, year & teacher name who taught you. Do you have or have you had any mental ailments including depression or anxiety? If yes, provide details.* *
Do you have or have you had any physical ailments? If yes, provide details.*
Please indicate below if you currently or previously have had any physical or mental ailments. * For Ex. Hernia, Neck or Back disease, Dislocations, Joint replacements, Injury, Depression, Anxiety etc. Please give details of the nature and duration of the condition and if you are currently undergoing any treatment: