Luzzo| Yoga Lessons - Intake Form

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Luzzo| Yoga Lessons - Intake Form

Hello! My name is Luzzo and I am a Yoga teacher based in Chicago, IL.

If you are interested in taking lessons with me, please fill out this form and I will be in touch. All questions are OPTIONAL.

More on my yoga practice can be found at http://www.luzzo.org/movement/yoga/

Email *

Name:

Pronouns/Salutations:

Phone:

Email:

Date of Birth:

YYYY

What brings you to yoga? What are you hoping to achieve in our sessions together? (Pain management, reduce anxiety, achieve certain postures, sleep better, etc.)

Please mark any areas of pain or tension:

Head

Neck

Shoulders

Arms

Elbows

Wrists

Upper Back

Lower Back

Glutes

Chest

Stomach

Hips

Thighs

Knees

Calves

Ankles

Feet

Other:

Please share any further details you'd like to share regarding your pain/tension:

Would you like hands-on assists or adjustments? I will also confirm this with you at the start of each session.

Yes

Depends

Other:

Clear selection

What is your experience with yoga? *

I have a daily personal practice.

I go to yoga class every day/every other day.

I sometimes take yoga class.

I do yoga on my own occasionally.

I've never done yoga.

Other:

What kind of yoga are you interested in? *

Restorative - Mostly on your back. 5-10 Poses a class. Utilizes somatic practices to ignite meditation and release chronic tension. Ambient music.

Fundamentals - Introduction to yoga vocabulary, pranayama (breathwork), and postures. Great for anyone interested in sustainable movement especially those who are new to yoga.

Hatha - Anatomical analysis of yoga postures. Heavy use of blocks and straps. Not flow.

Slow Flow - Vinyasa flow that is tempo-less. No pressure to move fast. Focus is internal with an emphasis on sustainability, pleasure, and rigor. Not restorative, you will sweat still..

Vinyasa Flow 1-2 - A flow class with unique choreography, inversions, balancing poses, and modifications. As class progresses, more complex modifications are introduced.

Handstands and Inversions - Workshop style privates! Start with a shortened flow to warm up. After that, we will integrate inversions utilizing props, the wall, and each other. Building strength and challenging our balance.

Other:

Required

Any specific requests (poses, techniques, or meditations) you would like to make sure we explore during our sessions?

Emergency Contact (Name, Phone, Email): *

What is the best way to contact you? *

Text

Call

I don't care.

Other:

Please use the below section to share WHEN you want your lessons. Please specify what days and times of the week that work for you and how many lessons a month. *

How long would you like your lessons?

1 Hour

1.5 Hours

2 Hours

Clear selection

Where would you like your lessons to occur?

Your Home - This would require space for two yoga mats.

Private Studio Space - A rented studio that only you and I will be present in.

Open Studio Space - A studio space that isn't rented meaning gym members may be sharing the space with us.

Other:

Clear selection

Any diagnoses, injuries, or surgeries you'd like me to be mindful of (include dates if applicable)

Submit

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