Chair Yoga + Nutrition Chat: Mini-Intake
Welcome! Before we stretch bodies and feed brains, answer a few quick questions. This helps me tailor our movement, nutrition topics, and handouts to what matters most to you. No perfection needed—just honesty.
Your name
*
Best email for reminders + class resources
*
example@example.com
What motivated you to sign up? (Pick all that fit)
*
Mobility
Brain-boosting nutrition tips
Energy and focus
Aging with strength
Community
Brain health curiosity
Other
#1 wellness priority right now
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Reducing inflammation
Improving mobility
Brain focus
Energy
Digestion
Healthier food habits
How would you describe your current activity level?
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Regular movement (most days)
Some movement (a few times a week)
Occasional movement (here and there)
Starting fresh (not much lately)
Do you have any physical limitations or concerns? (Select all that apply)
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Arthritis
Pain areas
Balance concerns
Recent surgery
None
Other
If you selected any physical limitation or concern, please share details (e.g., areas of pain, restrictions, or anything to help me support you).
How would you describe your eating habits lately?
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Mostly mindful and balanced
Trying to improve
Sometimes overwhelmed or inconsistent
Curious but not sure where to start
Any nutrition topics you’d love to learn about, or questions you have? (e.g., brain foods, meal planning, supplements, hydration, etc.)
Is there anything else you’d like me to know to support you best?
Would you like to receive details about a private 1:1 wellness upgrade?
*
Yes, send me details!
Not right now, thanks
If yes, what is your best email for follow-up?
*
I’m In!
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