Name * First Name Last Name Email * Phone * Country (###) ### #### What do you seek in practice? Check all options that apply meditation breathwork asana (physical postures) yoga philosphy spirituality injury rehabilitation stress relief relaxation flexibility/strength chanting How often do you practice? regularly (daily or weekly) occasionally (monthly) never (i'm new here!) What are your goals and expectations for our first session? * Do you suffer from any of the following health concerns? This is to minimize harm and keep you safe! arthritis asthma high blood pressure low blood pressure diabetes ear or eye issues back pain/problems knee pain/problems neck pain/problems headaches/migraines pregnancy recent procedures anxiety depression Preferred Date * MM DD YYYY Is there anything else you'd like to share? Thank you! 1-on-1 yoga session inquiry