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Yoga Concierge Program

There may be many reasons why you want to practice yoga, and we are here to design a personalized program that supports these reasons.

The Yoga Concierge Program involves a no-charge consultation to discuss your needs, and to help you choose the right styles of yoga, at the right frequency, and with the right variety to balance other aspects of your life.

To get started, fill out the intake form below. We will review it and set-up your free consultation. The consultation can be done over email, in a phone call, or we will sit down with you for a 20 minute scheduled appointment.

There is no purchase or attendance obligation, this program is simply a resource we provide to our new and existing members to help you get the most from your yoga practice, and to support active and engaged living.

Yoga Concierge Program Intake Form

Please complete the following form in detail. Your information is strictly confidential and will not be shared, printed, or saved on any non-secured local hard drives.

Yoga Concierge Intake Form

Your Information

Your Name *

Email *

Phone

Are you new to Kushala Yoga? *

Yes

No

Your Goals

Why do you want practice yoga, or why was yoga suggested to you? Describe any physical, psychological or other reasons.

What are your biggest barriers to having a regular yoga practice? (e.g.: time, money, motivation, lack of appropriate classes at the times you are able to attend, physical discomfort, didn’t enjoy it in the past, etc)

Your Health

Do you have any injuries or health concerns? Please describe. *

What physical activities do you do regularly (i.e. on a weekly basis) *

What is the nature of your daytime environment (work or otherwise)? e.g. sedentary or active, stress level, etc. *

Your Yoga Experience

Have you tried yoga before? *

Yes

No

Describe your previous yoga experience, if any. What styles have you tried, how frequently did you practice and for what lengths of time/periods of your life.

What have you liked / disliked about yoga? What about yoga has impacted you the most? What would have improved your experience?

Your Schedule

What times of the week are you able to attend class? Check all that apply, even if not every week. *

Weekday mornings

Weekday afternoons

Weekday evenings

Weekend mornings

Weekend afternoons

Weekend evenings

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