Yoga Intake Form

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Yoga Intake Form

Name *

Email *

Address *

Phone number *

Have you practiced yoga before? *

Yes

Please describe any areas that you experience any pain or discomfort, may have had any injuries/surgeries, or areas to avoid. *

Do you ever experience dizziness, headrush, limb numbness or lightheadedness? Explain below. *

Are you currently taking any blood thinners? If Yes, please list. *

Other:

What are your reasons for taking yoga classes? *

In increase flexibility

To improve muscle strength

To reduce muscle tension in neck / shoulders

To reduce tension in lower back

To reduce feelings of stress / Increase peace of mind

To improve balance / coordination

Other:

Required

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