Intake Form

Please take a moment to fill out this intake form so I can learn a little bit about you! This will help me understand how to best guide you during your yoga journey.

thank you!

Name

First Name

Last Name

Date of Birth

YYYY

Profession

Do you have a consistent yoga practice? Please elaborate.

Are you dealing with any recent injuries? If so, what?

Where in your body do you feel tension/discomfort?

How is your sleep lately?

How energized do you feel today? On a scale of 1 (very low energy) to 10 (very high energy)

Please rate your stress level, on a scale of 1-10. Are you anxious? If so, how do you manage?

What have you done today/in the last few days to spark joy?

What are your intentions in working together and where do you need the most support?

How do you feel about hand-on assists/adjustments?

Is there anything else you would like for me to know?

By selecting agree, you adhere to xyz