Client Intake Form

Client Intake Form

Personalised Yoga Practice
Welcome!

This form helps me tailor your Personalised Yoga Practice safely and effectively. Your information is stored securely and handled in accordance with our Privacy Policy.
Client Information
Name

First NameLast Name
Age
Experience with Yoga
How would you describe your experience with yoga, if any?
Mobility and Exercise
How would you describe your energy levels and movement capacity?
How would you describe your current flexibility?
How would you describe your current level of general fitness?
Please describe any regular exercise currently undertaken:
Personalised Yoga Practice
What are your main reasons for developing a personalised yoga practice? (tick as many that apply)

Other
Basic Health Information
Please indicate any of the following that relate to you:
If you’d like, you can briefly describe any of the above so your Personalised Yoga Practice can be designed safely. A detailed discussion can also take place during your consultation.
Please note: Some yoga practices may be inappropriate during menstruation and pregnancy. Please let me know during your consultation if you are pregnant or have concerns about menstruation during yoga practice.
Thank you for sharing this information. It helps me shape your sessions to best support your needs. All responses are kept confidential and managed in line with our Privacy Policy.
Should be Empty:

Client Information