Yoga Intake Form

Please complete this form before your first yoga session.

It helps me understand what you’re currently experiencing, what you may need, and how I can best support you. All information you share is kept strictly confidential between client and practitioner, and is used only for general assessment.

I recognize that sharing personal details can feel vulnerable. I will receive your words with respect, care, and without judgment.

Name*

Email*

Phone*

Emergency Contact*

Have you practiced yoga before?*

Yes

If yes, what styles of yoga?

Any injuries, sensitivities, or areas I should be aware of? (especially joints, back, neck, hips)*

What is your intention for this session? (e.g., relaxation, emotional release, flexibility, grounding)*

Anything else you’d like me to know?

Consent & Acknowledgement

I acknowledge that:

• Yoga and energy healing are complementary wellness practices and not a substitute for medical care.

• I am responsible for listening to my body and practicing within my limits.

• I will communicate any discomfort, pain, or emotional overwhelm during the session.

• Hands-on adjustments and light touch are always optional. I may decline at any time.

• All information I share is confidential.

I consent to participate in yoga sessions with Amy at Light, Love & Reiki.

Signature*

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Date*

Month

Day

Year

How did you hear about Amy / Light, Love & Reiki?

Friend / Family referral

Social media (Instagram, Facebook, etc.)

Namaspa Yoga & Massage

Website / Google search

Event / Workshop

Other

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