Yoga/Breathing Intro Form

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Please fill out this form-to help me learn more about you. I am pumped to get to know more about how I can help you feel better in your body. Please know that your information in not shared outside of this business. Thank you for your interest! ~Jen

Email *

Phone Number (text or call preferred) *

Name *

I have interest in the following classes offered:

Breathe Now

Yoga Form and Flow

My Experience With Yoga (select one)

I have never practiced yoga, but I am ready to learn.

I have some to little experience with yoga.

I have practiced yoga several times.

I am seeking a challenge in my yoga practice; i.e. handstands, headstands, press...

Other:

Clear selection

Pain Points

I tend to experience tension in my lower back

I tend to experience tension in my upper back

I tend to experience tension in my upper body, i.e. neck, shoulders, chest

I tend to feel very strong in my posture and have little to no pain in my body

Other:

Clear selection

Breathing

I'd like to know more about different breathing practices offered.

I have little to no interest in breathing practices offered.

Clear selection

What are you expecting to gain from the Breathe Now- OR -Yoga Form and Flow Course? *

I would prefer a personal/virtual check-in on the following day: *

Monday

Tuesday

Wednesday

Friday

Required

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