Dallas Yoga Center Privates-Intake Questionnaire Please email completed form to Camille@dallasyogacenter.com and
info@dallasyogacenter.com.
Print Name___________________________________________
Company Email Cell Ph____________________________
To help us better understand your needs please answer the following:
1. What are you interested in for this session?
a.
yoga (asana), meditation, sound, breathwork, wall ropes, or therapeutics? (circle any that apply)
2.
Have you practiced yoga previously? If so, what style and for how long?
3. Do you have any previous injuries or areas of ongoing concern? Where and how did they first occur? How did/do
you address them (what type of treatment did/do you undertake)?
4.
What are your goals from this session?
5.
When would you prefer a session (best days/times)? Please provide several options if possible.
6.
Would you prefer to come to the Dallas Yoga Center or an offsite location?
7.
Are you interested in a single session or is it possible that you would schedule additional sessions?
8.
Would you like to request a specific teacher or style of yoga?
9.
What is your current level of activity? What activities have you participated in previously?
10. What are the ages / age range of participants?
11. Are you new to Dallas Yoga Center? If yes, please also fill out our New Student Form.
*DYC requires a credit card on file prior to booking any private lesson.
**There is a 24 Cancellation Policy for all Private Yoga lessons.
**No charge if cancellation received with 24 hours, full payment required thereafter. Written cancellation sent to
info@dallasyogacenter.com via email is required
Signature________________________________________________ Date_________________