YOGA QUESTIONNAIRE

Please fill out the following form to set up Private, Group or Corporate Group Yoga session.

*All information is kept confidential

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Are you interested in Private, Group or Corporate Group Yoga?

What made you decide to inquire about yoga?

Do you practice yoga regularly or have you ever gone to a yoga class? If yes, what style of yoga?

Do you have any injuries, recent surgery or health conditions I should know about?

Is there anything specific you were hoping to address with yoga, such as stress, centering, posture, strength or flexibility in an area?

What is your motivation for taking yoga? Check all that apply:

Fun

Physical Health

Flexibility

Stress Reduction

Fitness

Mental Clarity

Joint Pain

Other

Is there anything else I should know in order to work best with you?