New Client Intake Form

First Name *
First Name
Phone *
Home Address *
Home Address
What types of yoga have you practiced? *
What are your main objectives for taking private yoga classes? *
Emergency Contact *
Emergency Contact
Emergency Contact Phone # *
Emergency Contact Phone #
For in-home clients: What types of props do you already have in your home to use? *
PLEASE READ CAREFULLY BEFORE SIGNING: I understand that yoga includes physical movement, breath-work, meditation, and stretching techniques. As is the case with all physical activity, I understand that the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort I will listen to my body, adjust or change the posture, and inform and seek assistance from my teacher. I know that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I also know that all suggestions made by the Yoga Instructor are just suggestions and I am responsible for doing my own research and consulting a doctor before starting any new regimens, including yoga and strength routines. I understand that yoga is not safe under certain medical conditions and take full responsibility for making the informed decision to practice yoga. I understand that Holistic Cure does not diagnose conditions nor do they prescribe or perform medical treatments, prescribe substances, nor interfere with the treatment of a licensed medical professional. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that yoga & holistic wellness can complement any medical or psychological care I may be receiving. I hereby release Holistic Cure from any liability as a result of the services received by me.