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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)
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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?
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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?
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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
HOME
ABOUT
About Annie
Our Values
SERVICES
AYURVEDIC WELLNESS
WELLNESS CLASSES
WORKPLACE WELLNESS
YOGA CLASSES
PRIVATE YOGA SESSIONS
YOGA TEACHER TRAINING
EVENTS
Vibrant Peru Journey
Retreats
RESOURCES
Tip Sheets
Free Yoga Practices
Recipes
Vibrant Soulful Book List
Podcasts
CALENDAR
BLOG
CONTACT
FREE DISCOVERY SESSION
