Marin Yoga - New Client Questionnaire

Marin Yoga - New Client Questionnaire

Share your details, pain and mobility, and upload three posture photos so Julia can confirm the right fit.
About Julia

Julia Lorimer, C-IAYT, e-RYT-500, is a Marin-based yoga therapist and pain relief specialist with over 30 years helping people resolve chronic pain, stiffness, and poor posture habits - so they can move, and live, without pain.

Her approach, By Nature's Design, draws on more than a decade of traditional Vedanta study under Sri Swami Dayananda Saraswati and 30 years of direct training with the BKS Iyengar family and senior Iyengar teachers Manouso Manos and Ramanand Patel.

Julia works with a small, hand-selected group of clients each month so she can give real, focused attention to your care. This short questionnaire helps her understand your needs and confirm it's the right fit before scheduling a call.
Client Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Pain, Mobility, and Daily Life
Where is your pain? Name 3 places in fields below:
Pain Point #1: Name your pain point
Pain Point #1: Pain level (1-10)
Pain Point #1: Is it Constant or Intermittent?
Pain Point #2: How often does it occur?
Pain Point #2: Name your pain point
Pain Point #2: Pain level (1-10)
Pain Point #2: Is it Constant or Intermittent?
Pain Point #2: How often does it occur?
Pain Point #3: Name your pain point
Pain Point #3: Pain level (1-10)
Pain Point #3: Is it constant or intermittent?
Pain Point #3: How often does it occur?
How much are you willing to do and to learn to get out of pain and to stay out of pain?
How would you describe your current mobility?
What is your occupation, or do you do any repetitive physical work or hobbies?
Do you have support at home for daily activities, or do you manage mostly on your own?
Prior Care and Fit
Have you worked with a yoga instructor, bodyworker, or massage therapist before?
If yes, what worked, and what didn't?
Because the body takes time to heal, personal sessions with Julia are 1.5 hours. The fee is $500. Is that investment possible for you right now?
Referral Source
How did you hear about Julia?
Who referred you?
Photos for Julia
Posture tells Julia a great deal before you ever meet - where you're carrying tension, how your body has adapted to pain or old injuries, and the kind of work that will actually help.

Photos for Julia:

1. Be sure to have good lighting or make sure the room is well lit
2. Front, back, one side (only needs one side)
3. Face (just the face)
Upload Posture Photos Here

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IMPORTANT NOTES FOR POSTURE PHOTOS ABOVE:

These photos let her evaluate that in advance, so your first session can go straight to what matters. A few easy ways to get these Posture Photos:

• Ask a family member, friend, or caregiver to take them on your phone

• Prop your phone on a stack of books or a small tripod and use the timer

• Stand in front of a full-length mirror and photograph your reflection

• Wear bathing suit, shorts, or fitted clothing so the lines of your body are visible
Thank You - Please Hit Submit Below
Thank you for taking the time to share this with us.

Julia personally reviews every submission to make sure she can offer you the personalized attention her practice is built around.

You'll hear back within a few business days to schedule a call or next steps.

Your photos are used only by Julia, for the purpose of evaluating your posture and needs.

They are never shared outside her practice and are discarded once no longer needed.

Please double check that all fields and photos are complete before clicking Submit below.
Should be Empty:

Marin Yoga - New Client Questionnaire

Client Information

Pain, Mobility, and Daily Life

Where is your pain? Name 3 places in fields below:

Prior Care and Fit

Referral Source

Photos for Julia

Thank You - Please Hit Submit Below