Yoga PT Client Intake Form
This form helps me design your structured training program. All programs are delivered in 12-week cycle. Please answer thoughtfully: your answers help me create the most effective program for your body, goals, and lifestyle.
Personal Details
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Occupation
Emergency Contact (Name and Number)
*
Coaching Options
Select your preferred coaching option
*
Program + Review
12 Week PT Program
Focus Areas
What areas of training would you like included in your program?
Strength training
Functional training
Yoga
Mobility work
Core training
Breathwork
Meditation
Health and Injuries
Do you have any current injuries or pain? Please specify location and rate severity (1–10)
Any previous major injuries or surgeries? Please describe.
Any diagnosed medical conditions?
Are you currently taking any medication? If yes, please list.
Have you been cleared for exercise by a medical professional?
*
Yes
No
Training Background
Have you worked with a trainer before?
Yes
No
Are you currently training? If yes, please describe your current routine.
What experience do you have with strength training, mobility, or yoga?
Goals
What are your main fitness goals? (Select all that apply)
*
Strength
Fat loss
Muscle tone
Mobility
Core strength
Pain reduction
Performance
General fitness
Injury Prevention
Posture
Other
How do you want to feel in your body six months from now?
Wellbeing Goals (optional): If you are interested in mentorship-level coaching, describe how you would like to develop your yoga, breathwork, and meditation practice over this period.
Lifestyle & Commitment
How many days per week can you train?
*
How much time (in minutes) can you dedicate per session?
*
Average sleep per night (in hours)
How would you rate your current stress level? (1 = Low, 10 = High)
Low
1
2
3
4
5
6
7
8
9
High
10
1 is Low, 10 is High
On a scale of 1–10, how committed are you to your progress?
*
Not committed
1
2
3
4
5
6
7
8
9
Fully committed
10
1 is Not committed, 10 is Fully committed
Mobility & Movement
Do you feel tight or restricted anywhere? Please describe.
Are there any movements that cause discomfort? Please specify.
Are you open to short guided mobility flows?
Yes
No
Equipment & Training Space
Where will you train?
*
Gym
Home
Both
What equipment do you have access to?
Optional: Embodied Wellbeing Mentorship
If you are interested in integrating yoga, breathwork, and meditation into your program:
Optional: How connected do you feel to your body and breath right now?
Optional: What do you hope to develop through embodied practices over the next 12 weeks?
Optional: Are you open to journaling, reflection, and coaching exercises as part of your practice?
Final Notes
Is there anything else you would like me to know before we begin your program?
Submit Intake Form
Should be Empty: