Free Yoga Studio Intake Form

Please complete this form to help us understand your needs and create a safe, personalized yoga experience for you.
Name
Age
Phone number
Emergency Contact
Emergency Contact Name
Phone number
Health History
Please check any conditions that apply to you.
Back pain
Arthritis
High blood pressure
Heart conditions
Recent surgery (within last 6 months)
Are you currently on any medications that could affect your practice?
If yes, please specify.
Yoga Experience
Have you practiced yoga before?
If yes, how often?
Occasionally
Weekly
Daily
What are your main goals for practicing yoga?
Flexibility
Strength
Stress relief
Pain management
Waiver and Consent
By signing, you confirm accurate info, understand activity risks, and waive studio/instructor liability for any practice injuries.
Name:
Date:
Thank you for your submission!
We appreciate you taking the time to submit.
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