Personalized Wellness

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Personalized Wellness - Intake Form

Thank you for your interest in personalized sessions with Zia Yoga & Wellness!
Please complete the following form so we can gather an idea of what you're seeking.

After submitting the form, we will respond by email or phone within 1-2 business days. Should you have any questions, please email info@ziayogawellness.com.

We look forward to creating a personalized wellness program for you!

Email *

First & Last Name *

Phone number *

What motivates you to seek private sessions? (check all that apply) *

Schedule flexibility

Personalized attention

Injury recovery

Prenatal / Postnatal

Other:

Required

What type of session are you seeking? (check all that apply) *

Vinyasa Flow

Prana Flow

Gentle

Yin

Restorative

Prenatal / Postnatal

Meditation

Other:

Required

Which location do you prefer? *

Virtual

Outdoors at Zia Yoga & Wellness (with COVID-19 safety precautions)

What is your availability for personalized sessions?

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Early Morning

Morning

Afternoon

Evening

What is your preferred frequency for personalized sessions? *

2 times weekly (8 per month)

1 time weekly (4 per month)

Single session

Other:

Is there anything else you would like us to know?

Send me a copy of my responses.

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