Intentional Intake This intake is intended to help us get to know more about you, what your goals are so that we can do our best to help guide and support you on your Yoga journey. You do not need to answer every question on this form. If something doesn’t make sense for you, just skip it. Give as little or as much detail as you like. The more we get a sense of where you are coming from the easier it will be for us help get you where you want to go. This will take about 15 minutes. If you would like to do this together over the phone, send us an email and we will schedule a time together.Name First Last Email PhoneHave you visited our studio before? Yes No Do you live in the area? Yes No Tell me about your experiences with our studio.If you’ve been to our studio before, tell me about your experiences at our studio or with our teachers.Have you been to other studios in Phoenix?If so, which ones? What did you love? Was there anything you didn’t love?If you’ve never been to a Yoga studio before what stopped you? A day in the life of... We take a holistic approach to life and our practice. This section is intended to help us understand what your day is like so that we can see where you may run into obstacles in achieving your goals and also to make sure that our studio can support your needs.Early MorningWake up time: First thing you do in the morning: Supplements: Breakfast time: Food: Drink: Energy level/how do you feel: Other: A day in the life of... We take a holistic approach to life and our practice. This section is intended to help us understand what your day is like so that we can see where you may run into obstacles in achieving your goals and also to make sure that our studio can support your needs.MorningWork day?: School day?: Kids at home? No kids?: Morning activities: Food: Drink: Energy level/how do you feel 10am: Other: A day in the life of... We take a holistic approach to life and our practice. This section is intended to help us understand what your day is like so that we can see where you may run into obstacles in achieving your goals and also to make sure that our studio can support your needs.LunchFood: Drink: Companions: Where: Other: A day in the life of... We take a holistic approach to life and our practice. This section is intended to help us understand what your day is like so that we can see where you may run into obstacles in achieving your goals and also to make sure that our studio can support your needs.AfternoonAfternoon activities: Food: Drink: Energy level/how do you feel 3pm: Energy level/how do you feel 5pm: A day in the life of... We take a holistic approach to life and our practice. This section is intended to help us understand what your day is like so that we can see where you may run into obstacles in achieving your goals and also to make sure that our studio can support your needs.EveningArrive home: Dinner time: Food: Drink: Companions: Where: Who cooked: Evening Ritual: A day in the life of... We take a holistic approach to life and our practice. This section is intended to help us understand what your day is like so that we can see where you may run into obstacles in achieving your goals and also to make sure that our studio can support your needs.BedtimeBedtime Ritual: Tomorrow's Prep: Bedtime: Asleep: Energy level/how do you feel 10pm: On a Scale of 1-10 what is your stress level?1 being the lowest level of stress, 10 being the highest 1 2 3 4 5 6 7 8 9 10 Your GoalsWhat do you want us to achieve together? What are your goals?Be specific, Ex. If you want to feel good, what does feeling good mean to you?Specific — LifestyleSpecific — BodyHow long do you realistically think it will take to achieve this goal?What are you doing right now to reach these goals?Is this working? Yes No Everyone has something that has the potential to stop them. What obstacles do you foresee standing in your way?Who is in your support system? Who is going to hold you accountable and keep you going strong?Are the members of your support system in favor of you reaching your goals? Your HistoryHow long has it been since you’ve felt like you were in your ideal shape? I know we’re at a diferent stage in your life and we can’t recreate this, but what were you doing then and who were you doing it with?What triggered you to stop?How long have you been thinking about reaching these goals?How serious are you about conquering this and making it happen? The FutureIf you can imagine what your life will look like when you achieve your goal(s), how will you feel? How will your life change? What will you do? The Technical DetailsDo you have an medical conditions, injuries or chronic conditions?Please describe any medical conditions including injuries or chronic conditions.Do you have aches/pains in any parts of your body?If yes, please describe the areas that you have injuries, aches & pains on the front and/or back of your body.Do you hold tension or stress in any areas?If yes, please describe the areas that you hold tension or stress on the front and/or back of your body. The Plan Now it's time for to create your plan. Based on your goal and lifestyle, we'll design a plan of action for what you’re going to do for the next three weeks. How many and what types of classes do you think will help you reach your goal?Let us know if you would like help with this. When you submit this form we will review it. We can discuss your plan together either over the phone or in the studio.NameThis field is for validation purposes and should be left unchanged. Δ
