Private Yoga Session Survey
Thank you for your interest a in private yoga sessions. Below are some questions to get the process started. During our initial meeting we'll use the information as a starting point towards understanding your goals and needs. Your answers will help me to customize our first session and maximize our time together.
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First Name *
Last Name *
Email *
Phone Number *
Preferred method of communication? *
What are your current goals? Check all that apply *
Required
What is your primary motivation for wanting to do one-on-one training now? Any detail you can give will help me to better understand. *
How is your body feeling right now? How would you describe your physical, mental or emotional state lately? *
How do you want to feel in your body? In your mind? In other words, describe what your "goal" state will be like. *
What are you willing to invest in yourself in order to move closer to your health and fitness goals? *
What is your current "Yoga" experience level? *
What kinds of 1-physical exercises and 2-mindfulness practices have you done or are currently doing? *
What are your major obstacles, emotional and physical, to meeting your health and fitness goals?
What are your interests?
High Interest
Interested
Moderate Interest
Indifferent
No Interest
Yoga poses, the physical practice (Asana)
Breath work (Pranayama)
Mind work (Meditation)
Chakra: energy interactions in the body
Yoga Philosophy: bringing yoga into everyday life
Clear selection
Body History
The following information will help me to customize your practice for optimal health and safety.
Are there any current discomforts or conditions that need to be taken into consideration? *
Are there any major injuries or surgeries you are recovering from? If so, please describe and explain what you are currently doing for treatment. *
Do you have concerns or would like to focus on any of the following areas? Select any and all that apply.
Area I'm concerned about
Area I'd like to focus on
Head and Neck
Joints and Muscle system
Anxiety / Depression
Digestive system
Respiratory system
Cardiovascular system
Clear selection
Which types of Private Yoga Sessions appeal to you the most?  I reside in Oregon City, Oregon and am available to make house and work calls within a 50-mile radius.   *
Preferred
Possible
Not Applicable
In Person, at your home
In Person, at my property
At your place of work
Zoom Meeting
Other: Is there anything else you want to tell me about yourself so I can be a better yoga instructor and coach for you?
Submit
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