Disclaimer
The information collected in this questionnaire is intended solely for the purpose of creating a personalized wellness plan. It does not constitute medical advice or diagnosis, and should not replace consultation with a qualified healthcare professional. Users are responsible for ensuring the accuracy of their information and understanding that results are for general guidance only. The organization assumes no liability for any misinterpretation or misuse of this data. Always seek the advice of your healthcare provider with any questions regarding your health or fitness.
Please note: This is a sample Private Yoga Intake Form for US clients, provided for illustrative purposes only. Actual forms may vary based on specific needs and legal considerations.
Private Yoga Intake Form (Sample Template)
Client Details:
Name: ________________________________
Date of Birth: __________________________
Contact Number: _________________________
Email Address: ___________________________
Health & Medical History:
Please provide any relevant health information, current medical conditions, or injuries that we should be aware of:
______________________________________________________________
Goals & Preferences:
Describe your main goals for yoga practice and any specific preferences or concerns:
______________________________________________________________
Session Details:
Preferred days/times for sessions:
___________________________
Frequency (e.g., weekly, bi-weekly): ___________________________
Consent & Agreement:
I confirm that the information provided is accurate and understand that I should inform the instructor of any changes to my health or circumstances.
Location, ______________________
Client Signature
Date