What's your name? * phone number Do you have any experience with yoga? (if so what kind) What is your main reason for wanting to start this practice? Address What's your email? * Please indicate any other type of "movement" activities you are involved in or have previously been involved in: Do you have any health issues that could impact your safety during a session? Do you have any body issues/injuries acute or chronic? Ongoing medications/supplements? In general, how would you rate your strength? (On a scale from 1-5, 1 being the least) How would you rate your flexibility? (Scale of 1-5, 1 being the least) How would you rate your balance? (On a scale of 1-5) How would you rate your endurance? (on a scale from 1-5) Out of the following, which would you like to improve? (as many as you like): Strength, balance, flexibility, endurance On a scale from 1-10, how happy are you with your body? (1 being least happy): On a scale from 1-10, how happy are you with your over all appearance? (If any) What change would you like to see happen to your body? (weight loss, muscle gain, toning): (If any) What specific part(s) of your body would you like to see the most change? What would that change look like to you? Please indicate if you would be interested in incorporating practices which benefit the following: immune system, cardiovascular system, skeletal system, digestive system, breathing problems, memory loss,asthma, autoimmune diseases, anxiety/panic attacks, arthritis, carpal tunnel syndrome, chronic fatigue syndrome, depression, heart disease, high blood pressure, infertility, insomnia, weightloss, psoriasis, skin issues, anti aging, facial yoga: If you have another condition you would like to adress which is not listed above, you may list it here: True or False: You are easily able to cope with many emotions. True or False: You are able to form intimate bonds with partners easily. True or False: You don't deserve happiness because of things you've done in the past True or False: You have a vision of your ultimate life goals True or False: Just the thought of your goals can give you motivation to push towars your vision. True or False: You always feel stable and secure, not matter what life throws at you, True or False: Loving yourself and others comes naturally to you. You rarely judge others. True or False: You trust your own gut instincts True or False: I will do anything to fit in with the crowd Do you feel as if you belong on Earth Do you exprience any of the following? Intense emotions, anxiety/worry about everyday concepts, low self worth/ tired no energy, depression, pessimism, self doubt? If you could feel any way you wanted, how would you describe it?