NEW CLIENT FORM

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Let me get to know you!
 All responses are kept strictly confidential.

Name *
Name
Birthdate *
Birthdate
I am interested in? *
Click all that apply
Please list all possibilities
Have you practiced yoga before? *
Please check all the words below that you would regularly use to describe yourself *
Please indicate your typical feelings about the following statements: *
Please indicate your typical feelings about the following statements:
I regularly sleep well and wake feeling rested.
I handle stressful situations well (such as a car accident, illness or job loss)
I have adequate relationship support from family, friends...etc.
If necessary, I am willing to work hard to modify my habits, lifestyle and mind.
Please be as specific as possible. Thank you for your time!