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Yoga Therapy Intake form

Yoga Therapy Intake form- page 2

Please fill out the following health declaration form in order to participate in our yoga therapeutic sessions. Some answers are  required -thank you.
It is my intention to create a safe, well-balanced yoga experience for you. part 2: 
Which do you find nurturing and supportive? select both if apply
Do you find yourself getting upset or irritated often?
Do you feel you have a mission or vocation in this life?
If yes, are you fulfilling it?

It has been proven our sleeping habits play a role in pain management:

Terms and conditions:

Your private insurance plan, or Medicare is not covered under our Yoga Therapy program. Any fees, billing must be paid before each session. You are under no obligation to commit to a specific number of yoga sessions, and may continue as needed (if needed).If you fail to show up without a 24 hr notice, you will have to pay a $50 non refundable cancelation fee. 

This form shall remain confidential and will not be shared with anyone unless we have your approval.

Your information will remain confidential and will not be shared or sold.

Thanks for submitting!

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