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What are your reasons for seeking yoga therapy?

Please provide more details on any checked boxes above.

What interventions or treatments have you done to help alleviate these conditions? Are there other services you're receiving to assist with this? (Massage therapy, acupuncture, physical therapy..)

Are you currently taking any medications? If yes, please list names and reasons for each medication.

Have you ever practiced yoga before? If so, what styles and for how long?

What other physical activity do you participate in?

How well do you sleep? Do you have trouble falling asleep or staying asleep? Do you feel rested in the morning?

Describe your eating habits and diet. How is your digestion/bowel movements?

How would you describe your overall energy level?

What do you do for fun? What in your life brings your joy and pleasure?

Is there anything else you would like to add?

When are you generally available for sessions? Please note that most sessions take place on weekdays during the late morning or afternoon. Weekend availability is very limited.

Please be as specific as possible. For example: Mondays 2-6pm, Thursdays 8am-12pm..

Yoga Therapy Policies: Clients must complete a Liability Waiver before their first session. Payment must be made at the time of booking. Purchases are non-refundable. Sessions expire one year from date of purchase. There is a 24-hour cancellation policy. Cancellations can be made online, by phone call, text, or email. Any cancellation made within 24 hours of the scheduled appointment time will be charged for the full amount.

Please enter your initials below to agree.

Yoga Therapy Intake Form

Tria Yoga

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