New Client Questionnaire

Welcome to our new client questionnaire. This questionnaire will be used for your free consultation, and will be kept in strict confidence. Please take your time to answer the questions. There may be questions that you would prefer not to answer until your consultation, but please keep in mind that knowledge is the key to getting the most out of your private yoga session.

Your Name (required)

Your Email (required)

What is your greatest challenge? Is it physical or do you perceive it otherwise?

Please list your physical issues? a) When do you feel they started?ex: as a child, adult b) Do you recall the root cause? ex: accident or trauma c) Are you currently in pain and where do you feel it?

What is your current profession? a) How long? b) Do you enjoy it? c) Is it physical? D) Do you sit a lot?

What other if any physical practices do you engage in? ex: walking, biking.

How many cups of coffee or tea do you drink per day?

Your diet: briefly describe this by listing for me your favorite foods.

Do you take supplements and or herbals?

Your daily water intake in oz? Include all the different types of liquid you drink.

Your Age?

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New Client Questionnaire

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