Name *

First Name

Last Name

Address *

Location of private yoga session.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Expected Due Date

If you are currently pregnant.

MM

DD

YYYY

Yoga Experience *

Which level best describes your yoga experience?

No experience

Beginner

Intermediate

Advance

Rate Your Stress Levels *

Low

Moderate

High

What are your goals/expectations for your yoga practice? What benefits are you looking for? *

Fitness

Increase flexibility

Injury rehabilitation

Lifestyle balance

Stress management

Weight loss

Policy Acknowledgment *

By checking this box, you acknowledge you have read and understand purchase and general policies.

I have read and understand Purchase and General Policies.

Waiver *

By checking this box, you acknowledge you have read and understand the client waiver. (Client waiver is also posted on Schedulicity booking site.)

I have read and understand the Client Waiver.

Current Date *

MM

DD

YYYY