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Yoga Client Intake Form

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Updated on July 11th, 2023

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

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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: _______________________

Why Use an Intake Form

Intake forms are recommended as they inform instructors of any potential risks, such as a new student’s medical history or current physical shape. As yoga can be a physically strenuous activity, the form provides a liability waiver requiring students to monitor themselves during class and avoid any dangerous or harmful movements or activities. The form is a useful tool for instructors to provide students with a safe and effective yoga experience.