YOGA WITH ALESSIA - Private Intake Form

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Thank you for your interest in private yoga sessions with me. In order to provide you with the most personalised yoga sessions, please complete the form below.

I am excited to work with you. If you have any questions, please do not hesitate to contact me.

PRIVATE YOGA INTAKE FORM

* Indicates required field

Full Name *

First

Last

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Email *

Phone Number *

What is the reason for requesting private yoga sessions? Please check all that apply. *

I am a beginner and want to practice in a one-on-one comfortable environment I am an intermediate level and want to deepen my practice and learn advanced postures There are not any group classes in my community that I relate to To increase my athletic performance To address an ailment or injury Other

Others (please specify) *

If you are requesting a private session to deepen your practice please list any specific areas of the body you want to focus on and any particular poses you want to explore. *

If you are requesting a private session to address an injury or ailment please describe this injury/ailment with as much information as possible. *

What would you like to get from your yoga practice? Check all that apply *

Muscle Strength Joint Stability Improve Posture Healthier Lifestyle Improve Sleep/Decrease Anxiety Spiritual Growth Study Yogic Philosophy Flexibility Increase Body Awareness Improve Mindfulness Improve Breathing Reduce Stress/Increase Peace of Mind Others

Others (please specify) *

Do you have any limitations, previous injuries, or health concerns I should be aware of? If so, please explain (i.e. hip/knee replacement, slipped disc, heart issues) *

Are you after a 5 class pack or a 10 class pack? *

I'll start with 5 classes and see how I go I'm all in and would like to purchase the 10 class pack and get 10% off I am not sure, I'd like more information

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St Kilda, Melbourne VIC
[email protected]

Home
About
Privates + Prenatal
Corporate Yoga
Contact