Private Yoga Session Intake Form
To ensure optimal outcomes from your private yoga sessions, I've created a straightforward questionnaire. Its purpose is to help us identify the primary objectives of your current practice. Rest assured, your responses, like all information shared during our sessions, remain completely confidential. The more candid you are in your answers, the better we can pinpoint the areas to focus on in achieving your goals. It's important to note that this questionnaire serves as a starting point; both your goals and our approach may evolve over time, and we'll adjust accordingly as we progress.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name and Relation to You
Full Name
Emergency Contact Number
(000) 000 - 0000
What is the reason for requesting private yoga sessions? Please check all that apply.
*
I want to practice one on one in a comfortable setting.
There are not any group classes in my area that suit my needs.
To address and ailment or injury.
I cannot find a class that fits my schedule.
What would you like to get from your yoga practice? Select the top 3.
*
Improve posture
Healthier Lifestyle
Improve sleep/ decrease anxiety
Flexibility
Improve breathing
Reduce stress/ Increase peace of mind
Have you ever practiced yoga before?
*
Yes
No
If yes, how often do you practice?
*
Please Select
Daily
Weekly
Monthly
Yoga interests?
*
Asana (poses)
Pranayama (breathwork)
Meditation (quieting the mind with visualization and breathwork)
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?
*
Yes
No
Are you interested in more than one private yoga session?
*
Yes
No
I am not sure yet.
I agree with the above guidelines and understand them.
*
Yes
No
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Yoga Session Guidelines and Agreement
To ensure our sessions are as effective as possible and to maximize our collaborative efforts, please adhere to these guidelines:- Commit to daily practice and exercise between sessions, if possible, to enhance progress and optimize our time together.- Allow adequate time for digestion before our session. Ideally, wait 2 hours after a meal or 1 hour after a snack before practicing yoga. Ensure you are well-hydrated beforehand, and feel free to drink water during our session as needed.- Wear comfortable, stretchy clothing that isn't too loose.- Don't hesitate to ask questions if there's anything you'd like clarification on or wish to delve deeper into.- If there are specific areas you wish to focus on, please let me know. It's also beneficial to periodically review your goals for our sessions to ensure we're effectively meeting your needs and objectives.
Terms
Please observe the following guidelines to ensure our sessions run smoothly and effectively:- Timeliness is crucial due to travel commitments and a busy client schedule. Sessions must begin and end promptly.- Dedicate uninterrupted time for the session by turning off cell phones.- Please note my 24-hour cancellation policy: Reschedule sessions at least 24 hours in advance of the appointment time.- Adhering to these guidelines maximizes the productivity and value of our sessions within the allotted time.
Release/Waiver of Liability and Agreement
I acknowledge that yoga involves physical movements and provides opportunities for relaxation, stress reduction, and relief of muscular tension. Like any physical activity, there is a risk of injury, including serious or disabling injuries, which cannot be completely eliminated. If I experience any discomfort or pain, I will listen to my body, adjust my posture, and seek assistance from the instructor. I will continue to breathe smoothly throughout the practice.I understand that yoga is not a substitute for medical examination, diagnosis, treatment, or medical attention. I confirm that I have consulted with a physician and have been cleared to participate in yoga sessions with Yellow Bug Yoga. By signing below, I agree to release and waive any present or future claims against Yellow Bug Yoga, its heirs, successors, or assigns. Please review and sign the service agreement and waiver to indicate your understanding.
Signature
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