Private Yoga Intake Form

Please complete this questionnaire before your first private session so we can understand your experience, preferences, and goals.

1. General & Contact Information

Full Name *

Email Address *

Phone Number *

Emergency Contact (Name & Relationship)

Emergency Contact Phone

4. Goal Setting & Intentions

What is your primary motivation for seeking private yoga sessions instead of group classes?

For example: specific poses, stress, schedule flexibility, or physical rehabilitation.

What would you like to achieve or feel immediately after our first session?

What are your long-term goals for your yoga practice over the next 3 to 6 months?

On a scale of 1–10, how would you rate your typical daily stress levels?

1 = completely relaxed; 10 = highly stressed/overwhelmed.

5. Health & Physical Considerations

Please list any areas of the body that currently feel tight, uncomfortable, or limited in range of motion

Are there any specific medical conditions, past injuries, or surgeries that may impact how you move or modify postures?

If applicable, are you currently pregnant or postpartum?

Yes No

If yes, due date or weeks postpartum

Session Interest

Please indicate which session type you are interested in *

Individual Private Session - $75 5 Session Package - $325 10 Session Package - $675

Private Yoga Session Intake Questionnaire