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Priyamvada Mangal Yoga and Mindfulness Classes/Consultation
Student interest and registration for Yoga classes All Over The World
222 + Hearts Touched
Website Testimonials: https://www.priyamvadamangalyoga.com/testimonials-1 
Google Reviews: https://share.google/X8aMkLCdkbWVx08kV
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What services are you interested in? *
Name(First, Last) *
Age
Birthdate *
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Current city and country of residence *
Weight (kg), Height (ft), BMI *
Full Address for offline class
What is your motivation to join the class *
Email *
Phone number *
Emergency contact name and number *
Education & College
Profession & Company *
Time and day preference for Yoga class *
Number of days you want the class *
Do you have any medical conditions? Please give a detailed response. All information is confidential. Please list to have a more targeted practice. *
Medicines taken past/ current(Please specify names)
Describe your approximate daily schedule. With time preferably.  *
Sleeping pattern—please specify position of sleep, approx. time, quality, etc. Sleeping and waking up time. Please be as descriptive as possible. *
Diet—frequency, quantity, allergies, etc. Please be as descriptive as possible. With time preferably. *
What kind of content do you like to consume? Favorite genres. Books, movies, and series. What are the recurring themes? *
Do you dream often? Any recurring dreams/themes?  *
Night/morning routine. Please be as descriptive as possible. *
Expectations, goals and motivation for joining the class *
What is your deepest dream? *
Please take some time to do this quiz https://kripalu.org/content/whats-your-dosha and enter your result example. Vata = 5; Pitta = 4; Kapha = 5 *
Have you done Yoga or any other kind of exercise before? Kindly elaborate. *
Please provide a reference for how you found me! *
Link to Social Media handle(FB/Insta/Twitter/LinkedIn)

I accept I have disclosed all the relevant information. I also understand that Priyamvada is not a medical professional or psychotherapist. Her responsibility is to teach yoga for a holistic and stress-free lifestyle. She does not claim instantaneous treatments or cures. All fees should be paid 24 hours in advance.

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