Àṣẹ Yoga and Meditation Intake Form

Àṣẹ Yoga and Meditation Intake Form

Thank you for your interest in our wellness services. Our private sessions are curated to focus on your specific needs such as alignment, philosophy, intentional and mindful movements and strengthening in the comfort of your home. To get started, please fill out the intake form. We will contact you to discuss how we can best work together. All information provided is confidential.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Are you interested in a virtual or in person yoga experience?

VirtualPrivate Residence or OfficeStudio SettingIn Nature (Park)
Estimated attendee count?
Have you ever practiced yoga before? If yes, how often do you practice?
Is there anything that you feel might be a trigger for you in a yoga class (i.e. certain postures/movements, conscious breath practice, smells/sounds etc)?
What are your current self care practices, hobbies and interests that are most valuable to you?
What would you like to get from your practice? Check all that apply.

Improve MindfulnessBuild Strength and MobilityImprove PostureImprove SleepJoint MobilityIncrease Body AwarenessImprove BreathingReduce StressHealthier Lifestyle
Which of the following offerings interest you? Our private sessions are 90 minutes, unless otherwise specified.

Guided MeditationPranayama (Breathing Techniques)Yoga, Meditation & Mindfulness Writing JournalSound Bath MeditationCannabis Inspired YogaChakra BalancingReiki Energy HealingPrivate Yoga In The Park Session(s) *Summer Only
Which styles of yoga do you normally practice?

VinyasaHatha - GentleYinRestorativePowerBikram - HotAshtangaOther
Which yoga props do you currently have?

MatYoga BlocksYoga BlanketsYoga StrapBolsterMeditation CushionYoga WheelOther
Do you have concerns about being touched or manually adjusted?
What are your goals or intentions for this session?
If this is a group session, briefly describe your needs.
Please feel free to share any additional information here.
Should be Empty: