Create Document
Fill & Sign
Adobe PDF
Microsoft Word
OpenDocument
A yoga client intake form is used by yoga instructors to obtain students’ information before beginning private or group yoga classes. It records information that helps instructors fit their courses to a student’s particular needs, such as their preferred style, previous yoga experience, areas of interest, and objectives or goals. The form also includes a liability waiver holding the student responsible for ensuring their own safety during classes.
Registering as a Yoga Instructor
There are no regulations in the U.S. requiring yoga instructors to be licensed or certified. However, many studios prefer to hire instructors that are registered with the Yoga Alliance or those who have completed an approved training course.
Sample
Download: PDF, Word (.docx), OpenDocument
YOGA CLIENT INTAKE FORM
DISCLAIMER: Thank you for your interest in being a client of [STUDIO NAME]. Information collected about new clients is confidential and will be treated accordingly.
| STUDENT GENERAL INFORMATION |
Name: ______________________________ Date of Birth: _____________
Address: ____________________________ Phone: ___________________
Emergency Contact Name: __________________ -Phone: _______________
Referred by: ___________________________________________________
| YOGA EXPERIENCE/GOALS |
Have you practiced yoga before? ☐ Yes ☐ No
-If yes, when was your last class/practice? _____________
How often do you practice yoga? ☐ Never ☐ Daily ☐ Weekly ☐ Monthly
What style of yoga have you practiced most frequently?
☐ Hatha ☐ Ashtanga ☐ Vinyasa/Flow ☐ Iyengar ☐ Power ☐ Anusara ☐ Bikram/Hot
☐ Forrest ☐ Kundalini ☐ Gentle ☐ Restorative/Yin ☐ Other: ___________________
What are your goals/expectations in yoga? What benefits do you seek?
☐ Strength training ☐ Flexibility ☐ Balance ☐ Stress relief ☐ Address health concern
☐ Improve fitness ☐ Weight management ☐ Increase well-being
☐ Injury rehabilitation ☐ Positive reinforcement ☐ Other: _______________________
What are your personal yoga interests?
☐ Asana (postures) ☐ Pranayama (breath work) ☐ Meditation ☐ Yoga philosophy
☐ Eastern energy systems ☐ Other: ______________________________________
| LIFESTYLE AND PHYSICAL HISTORY |
How do you rate your current level of physical activity?
☐ Very inactive ☐ Somewhat inactive ☐ Average ☐ Somewhat active ☐ Very active
On a scale of 1-10, how would you rate your level of stress? _____
Specify any conditions that have affected your health recently or in the past:
Are you currently taking any medications? ☐ Yes ☐ No
-If yes, please list the names and reasons for the medications:
| ACKNOWLEDGMENT |
Signature: _________________________ Date: ___________
Printed Name: _______________________