Client Intake Form | Soul Sanctuary Yoga

First name

Last name

Email

Phone

Birthday

Day

Month

Year

Emergency Contact Details

Do you have any of the following conditions or concerns? (Check all that apply)

Are you currently undergoing treatment or taking medications for any of the above conditions, if applicable?

Yes

No

If "Yes" to the above please provide details.

Do you have any injuries or conditions that may affect your ability to participate in yoga?

Yes

No

If "Yes" to the above please provide details.

Medical Confirmation

Yoga is a physical activity that may not be suitable for everyone. If you have any medical conditions, injuries, or concerns, please consult your doctor or healthcare provider before beginning yoga classes. By submitting this form, you acknowledge that you are responsible for your health and safety during yoga practice.

Acknowledgment and Waiver

I confirm that the information provided above is accurate and complete to the best of my knowledge. I understand that:

Instructors at Soul Sanctuary Yoga are not medical professionals and cannot diagnose or treat medical conditions.
It is my responsibility to consult with a healthcare professional before beginning yoga classes.
I participate in yoga at my own risk, and I release Soul Sanctuary Yoga and staff from any liability related to injuries or health conditions.

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