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New Yoga Client Questionnaire

Thank you for taking the time to fill out this brief form to help me better understand your health background and yoga wellness goals.

First Name

Last Name

EmailPhoneDo you currently practice yoga? If so, what style/type of yoga and how often do you practice?On a scale from 1 - 10, how physically active is your lifestyle? (10 being the most active)What other forms of movement/exercise do you do?On a scale from 1 - 10, how stressful is your life/job/ currently? (10 being most stressful)What aspects of yoga are most appealing to you?physical posturesrelaxationmeditationchantingbreathworkyoga philosophyself careYoga and Ayurvedic lifestyle tipsWhat are your goals and expectations from your yoga class?Do you suffer from any of the following health issues?ArthritisAsthmaHigh blood pressure
Low blood pressureDiabetesEar issuesEye issuesEpilepsyHeart conditionsMigrainesHeadachesBack pain/problemsKnee pain/problemsNeck pain/ problemsRecent fractures/sprainsRecent operationsAnxietyDepressionDo you have any other health issues that affect your mobility or are likely to cause you concern when practicing yoga?Anything else you would like me to know?Thank you for taking the time to fill out this form!

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