5 Day Hernia Push (No! No! Don't Push) Hernia Push!
Thank you so much for filling out this survey for hernias.
I am not a doctor, however I have been using yoga as therapy for the past 16 years and have had wonderful results. I will be putting together a short program based on the answers you provide. So again, Thank you!
Rachel Divine
Sign in to Google to save your progress. Learn more
Email *
Name *
First and last name
Phone number
1. Have you been diagnosed with a Hernia? *
Required
2. Do you know what kind of Hernia you have? *
Required
3. Did You Have Surgery? *
Required
4.  Do You Have Surgery Scheduled in The Next 3 -6 Months? *
Required
5. What is Your Pain Level? *
Required
6. Were You Told to Avoid Certain Activities? *
Required
7. What Were You Told to Avoid?
8. Were You Told to Do Certain Activities? *
Required
9. What Activities Were You Told What To Do?
10. Do You Currently Exercise? *
Required
11. What Kind of Exercise Do You Do? *
Required
12. Have You Ever Practiced Yoga? *
Required
13. Have You Considered Yoga Therapy for Hernias? *
Required
14. Would You Be Interested In Virtual Videos or Classes *
Required
15. If yes, How Many Times a Week Would Your Practice Yoga Virtually? *
Required
16. Would You Be interested in Attending Classes?   *
Required
17. If yes, How Many Times a Week Would Your Attend Yoga Classes? *
Required
Anything Else You Would Like to Add?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Yoga Divina. Report Abuse
Google Forms