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
Emergency Contact
Emergency Contact Name
Phone number
Health History
Please check any conditions that apply to you.
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Back pain
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Arthritis
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High blood pressure
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Heart conditions
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Recent surgery (within last 6 months)
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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?
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Occasionally
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Weekly
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Daily
What are your main goals for practicing yoga?
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Flexibility
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Strength
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Stress relief
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Pain management
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Waiver and Consent
By signing, you confirm accurate info, understand activity risks, and waive studio/instructor liability for any practice injuries.
Name:
Date:
Thank you for your submission!
We appreciate you taking the time to submit.
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