Client intake – With Love Yoga

Skip to content

About
Gallery
Contact
Gift cards
Policies & Waivers

Menu

About
Gallery
Contact
Gift cards
Policies & Waivers

Client intake

Name

Email

Phone number

Address

Date of birth

Have you practiced yoga before?

Yes No

If yes, why do you want to deepen your practice?

If no, why do you want to start yoga?

If yes, for how long have you been practicing yoga?

More than 3 years 1-3 years Less than 1 year

If yes, how often do you practice yoga?

2-4 times per week 1 time per week 1-3 times per month

What types of exercises are you currently doing?

What types of exercise have you done in the past?

Have you ever experienced a sports or exercise related injury? If yes, please describe.

Have you ever experienced any other acute injuries? If yes, please describe.

Do you have any chronic injuries or health conditions? If yes, please describe.

How often would you like to practice?

2-4 times per week Once a week 1-3 times per month

What is your primary yoga goal?

Increased flexibility & range of motion Relax and destress, cultivate peace and calm Recovery focused practice Build strength Meditation & mindfulness All of the above Other

If you answered "other," what do you want to focus on?

Anything else you want me to know?

What type of session/s are you interested in?

30 minutes 60 minutes 75 minutes 90 minutes Still deciding

Don't miss out!

Sign up to receive the latest discounts and information.

Email

Phone: (856) 254-2577

Email: withloveyoganj@gmail.com

Facebook-f Instagram