Yoga Client Intake Form

Information you will need

• What's your address?
• What's your home phone number?
• What's your cell phone number?
• What's your email address?
• What's your occupation?
• Who's your emergency contact?
• What's the emergency contact's phone number?
• Who were you referred by?
• STUDIO ONLY: What’s your name or the name of your studio?
• What’s your date of birth?
• Have you practiced yoga before?
• When did you last practice yoga?
• How often do you practice yoga?
• Have you frequently practiced Hatha yoga?
• Have you frequently practiced Ashtanga yoga?
• Have you frequently practiced Vinyasa or flow yoga?
• Have you frequently practiced Iyengar yoga?
• Have you frequently practiced power yoga?
• Have you frequently practiced Anusara yoga?
• Have you frequently practiced Bikram or hot yoga?
• Have you frequently practiced Forrest yoga?
• Have you frequently practiced Kundalini yoga?
• Have you frequently practiced gentle yoga?
• Are you seeking to use yoga as an alternative therapy?

…and 55 more fields in the PDF.

The form includes 1 signature line, a notary acknowledgment.