YOGA INTAKE FORM - CONFIDENTIAL INFORMATION
WELCOME! We would like to make your yoga experience at Wine & Unwind as effective and enjoyable as possible. If at any time you have questions regarding your session, please let us know.
First Name *
Last Name *
Zip Code *
Have you practiced yoga before?
How often do you practice yoga?
Style(s) of yoga practiced most frequently:
What are your goals/expectations for your yoga practice?
What benefits are you looking for?
How do you rate your current level of activity?
How would you rate yourl evel of stress? (1 is lowest,10 is highest)
List conditions that have affected your health either recently or in the past.
Are you currently taking any medications?
If yes, please list names and reason for medications.
If any of the information on this form needs to be detailed or if there is anything else to share, please do so:
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