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Yoga Therapy Interest Form
Thank you for your interest in working with me! Please complete this form so I can get to know a little bit about you. All answers will remain confidential.
- Lara Ramey, Yoga Therapist
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Full Name
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
What type of Yoga Therapy offerings are you interested in (select all that apply)?
*
Private, Virtual
Semi-Private/Small Group, Virtual
Private, In-Person (Austin, TX)
Semi-Private/Small Group, In-Person (Austin, TX)
Required
Briefly tell me why you are interested in Yoga Therapy. Please include your prior experience with Yoga or Yoga Therapy (if any) and any goals you have.
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Your answer
Are you working with a healthcare provider or other wellness modalities (e.g., Therapist, Chiropractor, Acupuncturist, Massage Therapist) for your goals? If "yes," please describe.
Your answer
Are you willing and open to work on your goals outside of your sessions? This would include at-home practices and/or skill-based work.
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Yes
No
I'm not sure
How many sessions are you interested in attending? My services require a minimum of 2 sessions.
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2
3-5
6+
I'm not sure
Is there anything else you'd like to share? If "yes," please use the space below to include any other information.
Your answer
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