Yoga Therapy Interest List
All sessions are held via Zoom.
Your Name
*
First Name
Last Name
Your Phone Number
*
Please enter a valid phone number.
Would you like to be texted when I am accepting new clients?
*
Yes
No
Your Email Address
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
How did you hear about ABWY?
*
Would you like to receive the ABWY monthly-ish newsletter to get first look updates on yoga programming?
*
Sign me up!
No Thanks
What kind of goals do you have in seeking yoga therapy? Examples might be recovering from an injury, improving the quality of your sleep, mobility concerns, mental health and mindfulness goals, etc.
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Growing takes time! A garden bed doesn't bloom in one day. Yoga therapy is a commitment of time, intention, and work. I can't and won't guarantee quick fixes! Are you ready to make an ongoing, consistent commitment to your growth and healing?
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Yes
I'm not sure
No
Please share any relevant health / injury / surgery history. If you have received any instructions from your medical provider about physical activity limitations, please include these details!
*
Yoga therapy is self pay only, though I can accept HSA or provide a superbill for reimbursement from your insurance provider (I cannot guarantee reimbursement). I personally subsidize two sliding scale client spaces. These spaces are meant for clients who are unemployed, or underemployed, or have other financial barriers that make the standard cost of yoga therapy prohibitive. Sliding scale is discounted 20-50% of the standard cost (currently $110 for intake session, $90 per follow up session). Would you like to be notified of sliding scale availability? Please check all that apply.
Yes, please notify me
I can only pay sliding scale
I need a 20% discount
I need a 30% discount
I need a 40% discount
I need a 50% discount
I do not need sliding scale
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