Dr. Hatem Eleishi Medical Center Yoga Therapy for Fibromyalgia

Registration of Interest Form
Welcome to the Yoga Therapy Program for Fibromyalgia at Dr. Hatem Eleishi Medical Center (DHMC).

https://storage.tally.so/607437dc-2b73-43e1-8a9a-b8a05349642a/000-Yoga-FMS.jpg

About Our Yoga Therapy Sessions

Our Yoga Therapy Program is specifically designed for patients with fibromyalgia. Sessions combine gentle, adapted yoga postures, controlled breathing, and relaxation techniques with the aim of helping reduce pain and stiffness, improve flexibility and sleep quality, and enhance physical and emotional well-being.

Program Structure

Session duration: 60 minutes Frequency: Once weekly Program duration: 6 weeks (6 sessions) Format: Individual or small-group sessions Intensity: Gentle and adapted to each participant's symptoms, physical abilities, and exercise tolerance

Provider: Sessions are conducted by a qualified physician with specialized yoga training in Canada.

Note: Unlike conventional fitness-oriented yoga classes, our sessions emphasize safe, comfortable movements and individualized adaptations for patients with fibromyalgia. Please complete this brief form to help us understand your needs and preferences. Our team will contact you with further details about the program.

Full Name

WhatsApp Number

Are you currently a patient at Dr. Hatem Eleishi Medical Center (DHMC)?

Yes, I am currently a patient at DHMC.

No, I am interested in attending yoga therapy sessions at DHMC while continuing my medical care elsewhere.

What would you most like to improve through yoga therapy?

Widespread pain and muscle stiffness

Sleep quality

Stress and emotional well-being

Flexibility and mobility

Physical fitness and ability to perform everyday activities

General relaxation and well-being

Other (please specify)

Have you practiced yoga before?

No, I am a beginner.

Yes, occasionally.

Yes, regularly.

Do you have any physical limitations or health concerns that we should consider when planning your yoga sessions?

How did you hear about our Yoga Therapy Program?

Dr. Hatem Eleishi or another rheumatologist at DHMC

DHMC Fibromyalgia Patient Booklet

DHMC social media

Recommendation from another patient, friend, or family member

Other (please specify)

Consent to Contact

I agree to be contacted by DHMC via WhatsApp regarding the Yoga Therapy Program. I understand that submitting this form is an expression of interest, not a confirmed booking, and that participation may require an initial assessment of suitability.