New Yoga Student Questionaire

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New Yoga Client Questionnaire

Thank you for taking the time to fill out this brief form to help me better understand your health background and yoga wellness goals.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Do you currently practice yoga? If so, what style/type of yoga and how often do you practice? *

On a scale from 1 - 10, how physically active is your lifestyle? (10 being the most active) *

What other forms of movement/exercise do you do? *

On a scale from 1 - 10, how stressful is your life/job/ currently? (10 being most stressful) *

What aspects of yoga are most appealing to you? *

physical postures relaxation meditation chanting breathwork yoga philosophy self care Yoga and Ayurvedic lifestyle tips

What are your goals and expectations from your yoga class? *

Do you suffer from any of the following health issues? *

Arthritis Asthma High blood pressure Low blood pressure Diabetes Ear issues Eye issues Epilepsy Heart conditions Migraines Headaches Back pain/problems Knee pain/problems Neck pain/ problems Recent fractures/sprains Recent operations Anxiety Depression

Do you have any other health issues that affect your mobility or are likely to cause you concern when practicing yoga? *

Anything else you would like me to know? *

Thank you for taking the time to fill out this form!

Submit

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HOME
ABOUT
- About Annie
- Our Values
SERVICES
EVENTS
- Retreats
- Vibrant Peru Journey
RESOURCES
CALENDAR
BLOG
CONTACT
FREE CONSULT