New Client Intake Form

New Client Intake Form

Tell us a little bit more about you. We will send you the registration link once you fill out this intake form. Make sure your email and phone number are correct. Expect a friendly phone call or text message from our admin team to follow up with you.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Birthdate*

MonthDayYear
Date
Which Intro Series are you interested in?*

Intro to PoleIntro to Lyra
What draws you to this Intro Series?*

I want to build more confidence in myself.I want to feel amazing and sexy in my own body.I am looking for new ways to be creative in my life.I want to find my voice. I'm not sure who I am or who I want to be.
How did you hear about us?*
Tell us a little more about why you want to start classes with us (optional)
Should be Empty: