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New Yoga Client Intake and Health History Form
Please fill out the following health declaration form in order to participate in our activity.
Have you practiced yoga before?
On a scale 1-10 (10 being highest), how would you rate your level of daily activity?
What styles of yoga have your pacticed before?
How often do you practice yoga?
Choose an option
On a scale 1-10 (10 being highest), how would you rate your level of daily stress?
What are your health goals for your yoga practice?
Improve overall health
Alternative therapy (explain below)
Address specific health concern (explain below)
Which aspects of yoga are you most interested in?
Other (explain below)
Please review the following list ad check any health conditions that apply to you or have applied to you recently.