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Private Yoga Intake
Session with McKenzie
Email *
First & Last Name *
Date of birth *
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What are your current reasons for seeing a yoga therapist?
Do you have a goal for our time together?
Please state the areas of discomfort in your body. Try to describe where they are located and type/degree of discomfort.
What are your favorite physical movements? Please describe.
Please describe your regular exercise program?
Where do you hold tension in the body?
What helps relieve tension in the body?
Where do you experience physical stiffness or discomfort?
What do you find helps relieve physical stiffness or discomfort?
What makes the physical stiffness or discomfort worse?
What are your perceived stress levels?
What are your current perceived stress level?
Clear selection
Do you experience anxiety, sadness or depression?
Clear selection
How do these feelings manifest in your physical body?
Describe your sleep habits.
Please describe your overall energy level.
Clear selection
Does your engery level fluctuate or stay consistent?
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When are you most energized?
When are you least energized?
What life challenges are your currently facing?
If you could change one thing, what would it be?
How much time would you like to devote to your own personal yoga therapy practice?
Clear selection
How much time (each day/week/month) CAN you devote to your own personal yoga therapy practice?
Clear selection
What do you hope to receive from Yoga Therapy sessions?
Is there anything else you'd like me to know before we start our work?
How did you hear about Yoga Therapy at Advanced Holstic Health?
Here at Advanced Holistic Health, we have a 24 HOUR CANCELLATION POLICY. This means that if a client cancels within 24 hours of their appointment window, they will be charged the full price of service. If you must cancel, we do ask that it is done at least 24 hours prior to your scheduled appointment. *
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A copy of your responses will be emailed to the address you provided.
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