Yoga Client Intake Form

A yoga client intake form is used by instructors to obtain students’ information before starting private or group yoga classes. It records details to help instructors suit their courses to a student’s needs, such as preferred style, yoga experience, areas of interest, and goals. The form includes a liability waiver holding the student responsible for their own safety during classes.

Yoga Client Intake Form

A yoga client intake form is used by instructors to obtain students’ information before starting private or group yoga classes. It records details to help instructors suit their courses to a student’s needs, such as preferred style, yoga experience, areas of interest, and goals. The form includes a liability waiver holding the student responsible for their own safety during classes.

Last updated October 8th, 2024

A yoga client intake form is used by instructors to obtain students’ information before starting private or group yoga classes. It records details to help instructors suit their courses to a student’s needs, such as preferred style, yoga experience, areas of interest, and goals. The form includes a liability waiver holding the student responsible for their own safety during classes.

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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: PDFWord (.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: _______________________