Intake form

Name *

Email address *

What is your primary goal for practicing yoga?

Please select at least one option.

Stress relief

Increased flexibility

Chronic pain management

Emotional balance

Mindfulness

Fitness

Do you have any prior experience with yoga?

If yes, please specify your experience level.

Are you currently experiencing any physical or mental health issues?

What type of yoga are you interested in?

Please select at least one option.

Hatha

Vinyasa

Therapeutic

Prenatal

Postnatal

Meditation

Pranayama

How often do you wish to practice yoga?

What is your preferred session format?

Do you have any dietary restrictions or preferences?

What is your age group?

Is there anything else you would like us to know?

Additional questions or comments

Yoga Health Centre– Holistic Yoga & Wellness