Kathy White Yoga - Intake Form
Yoga for everybody and every body! www.kathywhiteyoga.com

Kaiut Yoga was founded by a chiropractor in Brazil nearly 30 years ago. It is specifically addressing biomechanical health and freedom of movement. It has been designed for you to work through chronic pain and injuries, general aches and stiffness, and it will work for the inflexible, hyper flexible and the aging body.

Kaiut Yoga works to return the body to its optimum structure and functionality by targeting the joints, reprogramming the nervous system, and eliminating pain. The classes are all 1 hour long and are designed to slowly but surely create optimal health. Regular attendance (suggested twice a week) brings the full benefits.

The Kaiut Method enhances the body’s own innate capacity to heal keeping you as healthy, mobile and pain free as possible for as long as possible. With more freedom of body comes freedom of mind. Learn more about Kaiut at https://kaiutyoga.com

Complete this form to be eligible to attend your first three classes of Kaiut Yoga @kathywhiteyoga studio in Crofton for free (terms and conditions apply)**

**Vancouver Island Residents Only
**Free classes must be taken within a two week period
**Form must be fully completed
**Meet with Kathy prior to your first class

Email address *
First Name *
Your answer
Last Name *
Your answer
Are you a resident of Vancouver Island? *
What is your goal in practicing Kaiut Yoga? *
Your answer
How would you describe your general 'state of health'? *
How would you describe your general stress level? *
How would you describe your general sleep pattern? *
How would you describe your general nutrition? *
How would you describe your general activity level? *
If you are active, what kind of activity do you do? And how often? *
Your answer
Please indicate any current or past injuries and accidents *
Your answer
Please indicate any serious illnesses/conditions, past or present, and to what extent they affect your quality of life. *
Your answer
Please indicate any areas of aches & pains, or areas of chronic stiffness, and to what extent they affect your quality of life. *
Your answer
Is there anything else that you think Kathy should know about you prior to attending yoga? *
Your answer
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