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Private Yoga Intake Form
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Name
Your answer
Date
MM
/
DD
/
YYYY
What are your primary reasons for participating in private yoga sessions?
Learn about yoga
Alleviate pain
Stress management
Strengthen meditation practice
Other:
What is your expectation for your first session?
Your answer
What is your experience or exposure to yoga? Mindfulness? Meditation?
Your answer
If you have done yoga, what poses did you enjoy? Are there any poses that challenge you? Have you been injured by any poses?
Your answer
What is your daily life like in terms of how you spend your time (work, exercise, etc.)?
Your answer
Please list any injuries, major illness, medical diagnoses or anything else you consider important for me to consider while developing your yoga program.
Your answer
What other healing modalities are you currently working with?
Your answer
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