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Yoga Therapy Intake form

Therapy utilizes specific yoga tools such as postures, breathwork, and meditation techniques to cater to an individual’s physical, mental, and needs. Private and group sessions are offered both livestream and in-studio.

What is YT?

Regarding our time together: During our initial appointment, we will go over the information you've shared. Please dress in comfortable clothing to facilitate an assessment of your posture and strength.

Yoga Therapy Intake form

Please fill out the health declaration form below to participate in our yoga therapeutic sessions. This form can be completed by a caregiver or an individual responsible for providing contact information. Thank you!
Are you familiar with the practice of yoga therapy?
In case needed, do I have permission to receive information about your health from your healthcare provider? Required
Past Medical History: please indicate all that apply:
Past Surgical History
It is my intention to create a safe, well-balanced yoga experience for you. 

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