Hawaii Yoga Therapy
Hawaii Yoga Therapy Intake Form
Before your session we'd like to get to know you a bit . . .
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What is your age?
Less than 13
Prefer not to say
What are your current reasons for seeing a Yoga Therapist?
What Yoga Therapy tools are you most interested in?
Mudra & Mantra
If Other please specify:
List your current & previous health conditions? Please include any medical or mental diagnoses, surgeries, accidents, injuries, etc.
What are your favorite physical movements? Least favorite?
How often do you spend time in nature?
Once per week
2 to 3 times per week
Once per month
Less than once per month
How do you typically handle emotional and stressful situations?
If you could change one habit, what would it be?
What aspects of your life give you the most joy and pleasure?