Client Intake Form
The Basics
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Birthday
-
Month
-
Day
Year
Date
Emergency Contact
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Relationship
Yoga Experience
Have you practiced before?
*
Yes
No
How would you rate your experience level?
*
Beginner - Never stepped on a mat before
Beginner - knowledge of the basics
Intermediate
Advanced
Previously practiced but not active
If you have practiced before, what types of yoga do you enjoy or practice most?
Hatha (slower flow, hold poses a little longer)
Vinyasa (flow)
Power (build heat while moving through vinyasa)
Restorative/Yin
N/A
Other
If you have NOT practiced before, what types of yoga sound most appealing?
Hatha (slower flow, hold poses a little longer)
Vinyasa (flow)
Power (build heat while moving through vinyasa)
Restorative/Yin
N/A
Other
How many times a week do you engage in physical activity?
*
none
1-3
3-5
7
What other types of physical activity do you enjoy?
What are your goals/expectations for this practice?
Strength Training
Flexibility
Balance
Stress Relief
Weight management
Address Injury or health concern
Improve fitness and overall wellness (mind, body, and spirit)
Other
Do you have any current injuries?
Do you have any past injuries or ongoing issues I should be aware of?
Is there anything else I should know?
You are strong and beautiful!
Thank you for taking the time to invest in your experience by filling out this form!
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