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Preference/Intake Form

Please fill out the following form after booking an individual yoga session.

Name

Phone

How often do you meditate?

Never

Rarely

Often

Frequently

Physical Activity Level

Are you suffering from a medical condition, illness, or injury?

No

Yes

Email

Address

My Experience with Yoga

Are you interested in any specific type of yoga? If yes, please list.

Do you have an interest in any authors/teachings specific to yoga? If so, please list.

If you have an injury or concern that may alter your session, please elaborate below.

Initials

Is there something specific you are looking for in a yoga class?

Is there anything else you would like to share prior to our session?

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

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Preference/Intake Form

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eastandwestyoga.com@gmail.com

Bethesda, MD 20814

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