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Home
About
Classes
In Your School
Contact
Private Client Intake Form
Name
*
First Name
Last Name
Email Address
*
Date of Birth
MM
DD
YYYY
Have you ever practiced yoga before?
Yes
No
How frequently do you practice yoga?
Daily
Weekly
Monthly
On occasion
What style(s) of yoga do you normally practice?
Ashtanga
Vinyasa Flow
Restorative
Yin
Iyengar
Power
Bikram/Hot
Hatha/Gentle
What do you want to achieve from private yoga sessions?
Strength
Flexibility
Balance
Stress reduction
Address health concern
Alternative therapy
Improve fitness
Weight management
Enhance well-being
Injury rehabilitation
Positive reinforcement
To learn basic yoga postures/flow
Other
Yoga interests
Asana (physical postures)
Pranayama (breath work)
Meditation
Yoga philosophy
Other interest
What is your current level of fitness?
Very inactive
Fairly inactive
Average
Fairly active
Very active
On a scale of 1-10, (1 is lowest, 10 is highest) how would you rate your level of stress?
1
2
3
4
5
6
7
8
9
10
Please list any medical conditions that you currently have, or have affected your health in the past.
List any parts of your body that you would like to address during your private session.
Thank you!
