YOUR PRIVATE SESSION INTAKE FORM Name * First Name Last Name Email * Which area of focus are you interested in? (SELECT ALL THAT APPLY) WELLNESS CONSULTATION FIRE CIDER WORKSHOP INNER CHILD: LAUGHTER + COLORING MEDITATION YOGA YOGA OFF THE MAT MEDITATION NATURE BATHING What is your reason for seeking out one on one instruction? Please tell me your goals and expectations. Have you done any yoga before? Tell me about your lifestyle and professional work load. Do you sit at a desk? Stand all day? A lot of computer work? On a scale from 1 - 10, how stressful is your life/job/ currently? (10 being most stressful) * On a scale from 1 - 10, how physically active is your lifestyle? (10 being the most active) * Have you experienced any injuries, ailments, aches and pains? Is there anything else you would like me to know? I take full responsibility for my health and will not attend if I am sick or feeling discomfort. I am fully aware of this risk and hereby release Noble Alkhemy (Dee Davis) from any and all liability, negligence or other claims arising from or in any way connected with my participation in the private session. Signed: Date: Thank you! I am looking forward to connecting with you on your yoga journey.
