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Yoga Consultation Form

The Yoga Consultation Form Template lets people submit their details to you in order to be considered for your coaching or classes. Use this template to find out if someone has experience with activity, what physical state they are in, where they’re feeling pain, and more.

- Step 1 of 3

Personal Details

Name *

First

Last

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Date of Birth

Occupation

Dropdown

If other:

Have you practiced yoga previously?

Yes
No

Explain what that experience was like for you:

Emergency Contact

Name *

First

Last

Phone

Relationship

General Health

Do you have any medical conditions?

Yes
No

Please list all medical conditions:

Is there a possibility you could be pregnant?

Areas of Pain

Head
Neck
Shoulders
Arms
Hands
Fingers
Upper Back
Mid Back
Low Back
Hips
Glutes
Legs
Knees
Ankles
Feet
Toes
Other

Signature *

Date / Time *

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