New Client Form | Yoga With Hannah

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New Client Form
*Please fill out if you haven't already, even if you have practiced with me before.

First name

Last name

Phone

Address

Birthday

Day

Month

Year

Please list an emergency contact with relationship to you and phone number.

Have you ever practiced Yoga before?

Yes (please give more details in the box below)

If you answered Yes, can you please describe your Yoga experience in terms of years of practice and styles/forms of practice?

Health & Wellbeing (This information helps me tailor classes safely. Please tick any that apply)

Back pain / spinal Issues

Joint pain / arthritis

Heart condition

High/low blood pressure

Asthma or breathing difficulties

Pregnancy (current or recent)

Recent injuries or surgeries

Other

If you ticked any of the boxes above, please provide more details that might be relevant (e.g., restrictions, doctor’s advice, or anything I should be aware of)

How did you hear about Yoga with Hannah?

Friend / Family

Social Media (Facebook/Instagram)

Website / Google search

Local signage

Referred by a local health practitioner

Other

If you were referred by a health practitioner, please provide their name and clinic/practice.

Everyone comes to yoga for different reasons. What are you hoping to explore, develop, or gain through your practice? (e.g., release of tension, relaxation, stress management, strength, flexibility, mindfulness, recovery, overall wellbeing…)

Please tick this box to acknowledge that you have read and understood the Terms and Conditions

Please sign if you agree to the terms and conditions of practice.

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Photo credit on Home Page: Lisa Gackle
Photo credit on About Page: Folk Haus Artist
Artwork in Services Page photos by Alec Baker of Iwantja Arts

hello@yogawithhannah.com.au

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New Client Form *Please fill out if you haven't already, even if you have practiced with me before.

New Client Form
*Please fill out if you haven't already, even if you have practiced with me before.