Julie Middleton Movement and Wellness 1:1 Movement Class Intake Form

Julie Middleton Movement and Wellness 1:1 Movement Class Intake Form

Please provide your details and fitness goals to help me tailor our upcoming movement class to your needs.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What are your primary goals for this movement class? Up to 3*
Are you familiar with the Restore Your Core online program, Lauren Ohayon, or another RYC certified teacher?
What intensity would you prefer from this movement class with me?*
Are there any specific activities or styles you are interested in? (e.g., flow style, more body weight/pilates style, intuitive movement, mobility, strength, breath-work/meditation, intention setting before we begin to move, etc.) Include your top 3 preferences below.
Are you pregnant?

YesNo
Do you have any injuries, health conditions, or limitations I should be aware of?
Have you completed the movement class waiver? Please do so before we meet!

YesNot yet
Consent Convo.
This YOUR practice.
You can ALWAYS express your consent with a “yes” or “no” to any movement, tool (ex: yoga strap, a hands on evaluation of posture, etc.), invitation (ex: closing your eyes). At any time. ALWAYS. No need to explain. This can be done by saying a verbal “no” or by simply honoring what makes you feel comfortable and safe (ex: choosing a different movement, keeping your eyes open, etc.).

You are free to adjust a movement, find a restful pose, take a break, take a drink, use the restroom, or leave the session/movement practice at any time without explaining. I will always support you honoring your “yes” and “no”. Always.

If I use a word, invite you into a movement or tool, or move my body in ways you are uncomfortable with, at any time, I WANT you to let me know. Whether in the moment, or later in whatever form of communication you prefer.
This is YOUR practice.
Is there any language you prefer I avoid using? (ex: vulva, pelvic floor, penis, breast, nipple, butt, etc.) Please let me know in the space below.
Do you have any preferences around how we engage physically during this movement practice/assessment session? (example: please do not move behind my body, please do not touch me, please do not bring attention to my pelvic floor, etc.) Please let me know in the space below.
Should be Empty: