New Client Intake Form

This form needs to be completed by all new yoga clients, and all current clients once every twelve months. Once you complete the form a PDF copy will be emailed to you. If you have any questions about this form, please contact me.

Your name Street Address City State/Province Postal/Zip Code Your email Best Phone Number

Can you/would you like to receive text messages?
YesNo

Best way to communicate with you?
text messagevoice phone callemailany/all

What are you looking for at Chicken Yogi? (i.e. more flexibility, stress reduction, etc.) Do you have any health conditions I should be aware of during our time together?

I am aware of Chicken Yogi's cancellation policy. Customers are allowed one cancellation without prior communication. Cancellations must be received no less than 2 days before a scheduled session and that session may be rescheduled once. Any further cancellations may be rescheduled only at the discretion of Chicken Yogi. Please stay in communication when sessions are scheduled. By checking this box I agree to the cancellation policy. I agree

By signing this form, I agree that the information is true and correct to the best of my ability, and should any of this information change I will communicate with Chicken Yogi.

Today's Date:

Please sign in the box below.

84471