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First Name
Last Name
Age
Email
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Location
Are you comfortable with Telehealth sessions or do you prefer in-person sessions?
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What are your primary reasons for seeking out therapeutic yoga and meditation? (e.g., Stress reduction, anxiety management, improved sleep, emotional healing, physical limitations)
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Do you have any previous experience with yoga, somatic therapy or meditation?
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If yes, please describe your experience briefly (e.g., type of yoga practiced, frequency, duration).
Do you have any physical limitations or injuries we should be aware of?
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If yes, please provide details.
Are you currently pregnant?
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Do you have any concerns about whether yoga or breathwork is suitable for you based on our Important Advisory?
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If yes, please elaborate on your concerns.
What are your specific goals for this program? (e.g., Improve flexibility, reduce stress, manage anxiety, regulate your nervous system, enhance self-awareness, deepen connection with yourself)
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What format would you prefer for your sessions?
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Would you be interested in a specific focus area during your program, or are you open to a blended approach? (e.g., Deepen your meditation practice, explore breathwork, address specific mental health concerns)
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Is there anything else you would like to share about yourself or your expectations for the program?
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