Free Yoga Studio Intake Form Template

Yoga Studio Intake Form

Please complete this form to help us understand your needs and create a safe, personalized yoga experience for you.

Name

    Age

      Phone number

        Email

          Emergency Contact

          Emergency Contact Name

            Phone number

              Health History

              Please check any conditions that apply to you.

                • Back pain

                • Arthritis

                • High blood pressure

                • Heart conditions

                • Recent surgery (within last 6 months)

                Are you currently on any medications that could affect your practice?

                If yes, please specify.

                  Yoga Experience

                  Have you practiced yoga before?

                  If yes, how often?

                    • Occasionally

                    • Weekly

                    • Daily

                    What are your main goals for practicing yoga?

                      • Flexibility

                      • Strength

                      • Stress relief

                      • Pain management

                      Waiver and Consent

                      By signing, you confirm accurate info, understand activity risks, and waive studio/instructor liability for any practice injuries.

                      Name:

                      Date:

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