Please fill out the form below and answer all of the questions.
Emergency Contact Phone
1. When did you complete your 200 hour yoga teacher training program?
2. Why did you choose that program?
3. Do you teach now?
4. The reason I would like to attend this program is?
5. The area I have the most room to grow is...
6. Describe the evolution of your yoga practice.
7. Have you ever been in recovery or a treatment facility?
If yes when and for how long?
8. Are you on medication?
If yes, please list:
9. Have you been diagnosed with a medical condition?
Do you take mediation for this?
10. Do you see a therapist?
11. In the last 12 months have you had any life changing events take place, such as: moving, divorce, lost job, changed job, given birth or suffered a major loss?
12. Do you use drugs?
13. Describe your eating habits and diet.
14. Describe your living conditions.
15. How many hours per week do you work?
16. Do you have children and/or pets?
17. Describe your support system
18. Have you had any major traumas or accidents in your life?
19. How did you hear about this program?