Intake Form

Name

Date of Birth

Street Address

Email Address

Phone

Occupation

Emergency Contact

Accessibility Needs

Referred By

What is your yoga experience?

How often do you practice yoga?

What time of day is best for you to practice?

Do you prefer 60- or 90-minute classes?

What types of Yoga have you practiced?

What are your goals?

What is your current rate of activity?

How do you rate your overall stress level?

What is important to you? What is important to you? Variety of classes Experience of instruction Price Cleanlines of studio Location Being greeted by name Schedule Retail

Is there anything else you would like to share?