State of Flow Yoga
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Beats, Bass and Breath | Denver
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New Client Intake Form
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Name
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Email
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Emergency Contact (Name & Phone Number)
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Occupation / Industry
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Age
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Phone Number
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How did you hear about us?
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Internet search (Google)
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Requested Day(s) for Sessions:
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
If other, please specify
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Requested Time(s)
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Yoga Experience
Have you practiced yoga before?
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If yes, how often
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Everyday
Once per week
2-3 time per week
Once per month
Less than once per month
Only once or twice ever
What are your interests in yoga? (Check all that apply)
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Asana (Physical Practice)
Pranayma (Breath work)
Meditation
Yoga Philosophy
Yoga for Pregnancy
Yoga for ADHD
What style(s) of yoga do you normally practice? (Check any that apply)
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Ashtanga
Vinyasa Flow
Restorative / Gentle
Yin
Iyengar
Power / Hot
Bikram / Hot
Hatha/Strong
Forest Yoga
Lifestyle & Fitness
What is your current level of activity?
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Very Inactive - Mostly Sedentary
Fairly Inactive - Occasional activity
Average - Some consistent activity
Fairly Active - 2-3 workouts per week
Very Active - 4-7 work outs per week
On a scale from 1-10 ( 1 = lowest, 10 = highest) How would you rate your current stress level
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9
10
What Activities or Actions do you do daily? (Work AND/OR Leisure)
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What activities or strategies, if any, do you use to combat stress?
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Home
Yoga
Yoga - Studio Classes
Beats, Bass and Breath | Denver
Recorded Clases
Private Yoga Instruction
Learn about the Chakra system
About
Contact
Blog