Name
Birthdate
/
Month
/
Day
Year
Date
Address
Email Address
example@example.com
Phone Number
Have you ever done yoga before?
Have you ever done aerial yoga before?
Are you interested in increased flexibility?
Are you interested in stress reduction?
Are you interested in strengthening and toning your body?
Do you exercise regularly?
Do you eat a healthy and balanced diet?
Do you lose balance easily?
Do you feel pain when you exercise? Where?
*
Do you have any tension or soreness in any areas? Where?
Do you have a bone or joint problem that could be worsening by a change in your physical activity?
Do you have a heart condition?
Do you have high blood pressure?
Do you have low blood pressure?
Are you taking any prescribed medications or dietary supplementation?
Are you pregnant or postpartum?
Have you ever been advised by a doctor, physician or specialist not to perform any type of exercise/ activity? if yes, why?
*
Open Response Questions
Why are you interested in yoga or aerial yoga?
Do you have time to commit to your wellness?
Is there anything else you want us to know?
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