Leslie Kaminoff Preventing and Healing Injuries Through Yoga, Case Studies and Clinical Observations intake
We are looking for applicants with a physical concern that can be addressed through the therapeutic modalities of breath, movement and awareness.

Submitting this form is your request to be a subject for the clinical observation component.

TIME COMMITMENT:  1-2 hours either Monday or Tuesday, February 2 and 3

SCHEDULING: Please select at least two time slots that would work for you. We will be scheduling guests over the weekend.
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First Name *
Last Name *
Email Address *
Phone Number *
Age *
Gender identification
Are you a yoga teacher or movement professional? *
Fully describe the issue that makes you want to be a clinic client. *
Have you received a medical diagnosis? If yes, please include. *
Describe your symptoms, including any of these factors you know: cause, onset, frequency, triggers. *
Describe how your symptoms impact participation in daily activities; i.e. work, leisure, exercise, etc. Are there activities you'd particularly like to resume? *
How have you attempted to manage this issue? What, if anything helps? *
What else should we know about you?
How did you hear about the clinic? *
Please indicate which date and time slot(s) work for you. The time commitment is 1-2 hours on Monday February 2 or Tuesday February 3. *
Required
In applying to be a client of the ABCs, you acknowledge that some aspects of your situation or the work you do with Leslie may be shared in the context of an article or presentation in the near future. No personal or identifying information as the client would be included. *
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