Auric Wellness Experience Intake Form

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Thank you for expressing interest in Auric Experience's wellness experience.

By completing this form honestly and thoroughly, you will help me better customize our session(s) together in a way that will not only address your physical needs but also deepen awareness and open your heart.

Once I receive the completed form, I will follow up regarding any final details, if necessary. Thank you for trusting me to lead your practice. Namaste

Email *

Preferred Name *

Which offering are you interested in? *

Kid's Yoga

Couples Yoga

Group Yoga

Private Yoga

Required

How often do you exercise or strengthen your body? *

How often do you stretch your body? *

How often do you meditate? *

What has been your experience of yoga and meditation? *

How would you describe your breathing style? *

My breath is typically full, even, steady

I breathe in a choppy or inconsistent way

Hold my breath throughout the day

I'm not aware of my breath

Other:

Required

Why wellness? Why now? What are your intentions?

Are you facing any psychological challenges or emotional struggles that you'd like for me to know about? Would you like to address any specific challenges or themes during our session together? (If so, please explain) *

Do you have any physical limitations, medical conditions or injuries I should be aware of? *

I agree to assume full responsibility for any injuries sustained and I release Auric Experience from any and all liability as a consequence of my participation in yoga classes. *

I agree

I disagree

Required

Submit

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