Private Yoga Questionnaire

Private Yoga Questionnaire

In order to facilitate the best result for your private yoga sessions, I have developed this simple questionnaire to aid us both in recognizing the main goals of your practice at this time. These answers, like anything that is revealed to me in our private sessions, is exactly that, private. The more honest you are in these sessions, the more we can pinpoint the areas of work that we should focus on in relation to your goals. Remember, this is simply a starting point, your goals and our line of study may change over time and we will address that as it arises.
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact name & relation to you*

Full NameRelation
Emergency contact phone*
Please enter a valid phone number.
What is the reason for requesting private yoga sessions? Please check all that apply.*

I am a beginner and want to practice in a one-on-one comfortable environmentThere are not any group classes in my community that I relate toTo address an ailment or injuryI can not find a class that suits me and my scheduleOther
What would you like to get from your yoga practice? Check all that apply*

Muscle StrengthJoint StabilityImprove PostureHealthier LifestyleImprove Sleep/Decrease AnxietyFlexibilityIncrease Body AwarenessImprove MindfulnessImprove BreathingReduce Stress/Increase Peace of MindOther
What yoga props do you currently have?*

MatBlock(s)StrapBlanketBolsterYoga WheelOther
Yoga Experience
Have you ever practiced yoga before?*

YesNo
If yes, how often do you practice yoga?
Yoga interests*

Asana (Physical practice)Pranayama (breath work)Meditation
What styles of yoga do you normally practice?*

Hatha/GentleBikram/HotPowerIyengarYinRestorativeVinyasa FlowAshtangaOther
What other physical exercise do you do (how many times per week / for how long)?*
What do you hope to gain from private yoga sessions?*
What would you like to work on in our session(s)?*
Please describe any health issues or concerns, such as injuries, illnesses, areas of tightness/discomfort, etc.*
Do you have concerns about being touched or manually adjusted?*

YesNo
Were You Referred By Anyone?

Client referral/FriendSearch engineSocial MediaOther
Are you interested in more than one private yoga session?*

YesNoI am not sure, I'd like more information
Please be aware:

We meet at the studio for all sessions.

The first payment of $120 includes 2 private sessions and 30 min consultation.

Hourly rate starts at $60/hr.

This price may vary depending on what is required and requested in the sessions.

*Prices subject to change
Package Deals & Rates

Sessions	Price	Savings
1 Session	$60
4 Sessions*	$225	$14
6 Sessions*	$331	$28
10 Sessions*	$540	$60

Rates for private clients and sessions will be determined after the initial meeting and evaluation, but generally range from $60/hr (Distance/Location Charges will apply)

Price is based on private instruction within your own home.

Off-site studio space is available - additional rates apply

*All packages expire 6 months from date of first session & are non-refundable/non-transferrable
If any of the information on this form needs further detail, you answered "other" or if there is anything else to share, please do so:
Yoga Session Guidelines and Agreement
Guidelines

To make our sessions as productive as possible and to get the most out of our work together, please follow these guidelines:

• If you are willing, dedicate daily practice and exercise time between lessons. This will ensure maximum progress and optimize our time together.
• Let meals or snacks digest before our session. Before practicing yoga, plan on giving yourself time to digest (2 hours after a meal, 1 hour after a snack). Please hydrate adequately beforehand. You may drink water during our session as needed.
• Please wear comfortable clothes that are stretchy, but not too loose.
• Ask questions! Please inquire if there is anything you do not understand or want to learn more about.
• If there is anything in particular you want to work on, please ask. Periodically it will be helpful also to review together your goals for these sessions so we are sure you are getting the most out of working together.

Terms

• Please be on time. Due to travel time and full client schedule, sessions must start and end on time.
• Carve out time for the session with no interruptions. Please turn off cell phones.
• 24-hour cancellation policy:
If a session needs to be rescheduled, please do so within 24 hours of the scheduled appointment. If cancellation is made with less than 24-hours notice, the full rate of the session will be charged.
• Time is limited and sessions will be most fruitful when these guidelines are followed.
Release/Waiver of Liability and Agreement
I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. I will continue to breathe smoothly. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I have been checked by my doctor and cleared to practice yoga prior to signing up for private lessons with Yogatation. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Yogatation, their heirs, successors or assigns.

Please read the service agreement & waiver.
Please check both boxes to show that you have red and understand.
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Private Yoga Questionnaire

Yoga Experience

Package Deals & Rates

Yoga Session Guidelines and Agreement

Release/Waiver of Liability and Agreement