About You :

Your Name

Contact Number

Email Address

About your current practice :

Where do you currently practice?

How long have you been practicing yoga?
0 - 3 months3 - 6 months6 - 12 months12 - 24 monthsMore than 2 yrs.

How often do you practice? (classes, at home, other)

What is your current level of health and fitness?

Do you have any health issues?
YesNo

Do you have any aches and pains?
YesNo

What is the main benefit you get from yoga?

What do you least like about your current yoga practice?

How do you rate

a) Your balance
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b) Your flexibility
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c) Your strength
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d) Your breath control
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e) Your muscle tone
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Do you sleep soundly?
YesNo

Do you worry more than most?
YesNo

Do you suffer with stress?
YesNo

Your progression plans

What are your aims over the next:

a) 6 weeks

b) 3 months

c) 6 months

d) 1 Year

e) 5 years

What would you like to learn more about Yoga?
Wider range of postures and balances?Increased awareness of pranayama and yogic breathingPhilosophy and history of yogaAnatomy and physiologyMeditation

Which postures would you like to develop?
Inversions and balancesForward and backbendsTwists and stretchesSeated postureRelaxation and restoration

Would you like to develop a practice in other areas?
Hot yoga ( hatha classes in 90 degrees heated studio)Aerial Yoga (using yoga swings)Ashtanga Yoga (strong yoga practice)Vinyasa yoga (fast flowing yoga)Yin Yoga (slow and deep stretch yoga)Meditation (focusing on your mind)Pranayama (using breathing techniques)

Barriers to progress

What would prevent you from developing your yoga practice?

Other options

Would you consider?
Smaller classesOne to one personal trainingTraining courses and workshopsRetreatsJoining a yoga practitioners social group

Other Comments