Please submit the form below at least 48 hours before your first session and bring a signed copy of the Service Waiver to your appointment.

Thank you!

DOWNLOAD SERVICE WAIVER

NEW STUDENT INTAKE FORM

Today's Date

MM

DD

YYYY

Name

First Name

Last Name

Email Address

Please list any musculoskeletal injuries (breaks, sprains, tears, pulled muscles, surgeries, etc.)

When did the injury first occur? Is it an on-going issue? If so please explain.

What treatment (if any) did you do or receive for said injury?

Checkbox

Do you have any previous experience in the following (check all that apply):

Yoga

Meditation

Pilates

Yoga

Meditation

Pilates

What are you hoping to gain out of working together? Any specific goals?

Describe any observations or concerns regarding your physical body, energy levels, and emotional/mental state that contribute to you seeking out private sessions.

Is there anything else you think I should know about you and your lifestyle? (work, stress, sleep, nutrition, etc.)