Name
*
First Name
Last Name
Email Address
*
Phone
*
Are you seeking private yoga or meditation, or both?
*
Yoga
Meditation
Both
What do you hop to gain from these sessions? Please check all that apply
*
Where would you like to practice?
*
What is your desired frequency for these sessions?
*
Once a week
2-3 times a week
4-5 times a week
Once a month
Describe your level of physical activity and/or current yoga practice, if applicable
List any injuries, traumas, health conditions and duration of current issue
If you are seeking private yoga sessions for therapy, please indicate whether you are seeing another professional for your health concerns
Please describe your lifestyle (ex. job, energy level, diet, elimination, hobbies, sleep)
Where do you hold tension in your body?
What kind of yoga practice are you looking for, if applicable?
Physical
Spiritual
Intense
Restorative
Recovery
Training
Maintenance