Chair Yoga + Nutrition Chat: Mini-Intake

Chair Yoga + Nutrition Chat: Mini-Intake

Welcome! Before we stretch bodies and feed brains, answer a few quick questions. This helps tailor movement, nutrition topics, and handouts to what matters most to the participant. No perfection needed—just honesty.
Participant Name*

First NameLast Name
Email Address (for reminders and class resources)*
example@example.com
What motivated you to sign up? (Pick all that fit)*

Mobility without joint painBrain-boosting nutrition tipsMore energy and focusAging with strength and sassCommunity and connectionCuriosity about brain healthOther (please specify)
What is your #1 wellness priority right now?*

Reducing inflammation or painImproving mobility or balanceSupporting brain focus or memoryBoosting energyImproving digestion or gut healthBuilding healthier food habits
How would you describe your current activity level?*

I move regularly and feel confident with gentle exercise.I move sometimes, but want to be more consistent.I'm starting fresh or returning after a break.I'm not sure what movement is safe for me right now.
Do you have any physical limitations or concerns? (Select all that apply)*

ArthritisNeck or shoulder painHip pain or had hip surgery replacementKnee pain or had knee surgery or replacementBalance concernsRecent surgeryNoneOther (please specify)
If you selected any physical limitations or concerns, please share more details (for example: specific movements to avoid, recent injuries, or anything else you'd like the instructor to know).
Which best describes your current eating habits?*

I feel mindful and open to learning new nutrition ideas.I try to eat well, but sometimes get off track.I feel overwhelmed by nutrition advice and want simple steps.I’m not sure where to start with nutrition.
What nutrition topics are you most interested in? (e.g., meal planning, brain foods, anti-inflammatory eating, healthy snacks, label reading, etc.)
Is there anything else you'd like to share to help us support you?
Are you interested in a private 1:1 wellness upgrade?*

Yes, send me detailsNot at this time
If yes, please confirm your best email address for 1:1 details:*
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