Intake form

Name *

Email address *

What are your primary goals for yoga therapy?

Please select at least one option.

Physical well-being

Mental well-being

Stress relief

Increased flexibility

Pain management

Emotional balance

What is your experience level with yoga?

Do you have any specific physical conditions or injuries?

What type of meditation are you interested in?

Please select at least one option.

Guided meditation

Mindfulness meditation

Breath awareness

Loving-kindness meditation

Body scan meditation

How often do you practice yoga or meditation?

What is your preferred session length?

Are you looking for one-on-one coaching or group sessions?

What days of the week are you available for sessions?

Please select at least one option.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

What time of day do you prefer for sessions?

Please select at least one option.

Morning

Afternoon

Evening

How did you hear about yogatherapie 'by jenni'?

Which service or services are you interested in?

Please select at least one option.

Guided meditations

Customized coaching

Yoga therapy

Additional questions or comments

Yogatherapie 'by Jenni'