Policy Notice
The information provided here is intended solely for reference regarding intake procedures and client intake forms related to therapeutic yoga services. It is not legal advice and should not replace consultation with a qualified health professional or legal expert familiar with applicable laws. Regulations and requirements may differ based on location, and adjustments may be necessary to ensure proper compliance. The use of this template is at the user’s own risk, and no liability is assumed for any errors, omissions, or consequences resulting from its use without professional guidance.
Please note: This is a sample Yoga Therapy Intake Form for the US, provided for illustration only. Actual forms may vary based on individual needs and professional assessments.
Yoga Therapy Intake Form (Sample)
Client Details:
Name: ____________________________
Date of Birth: _____________________
Contact Number: ____________________
Email Address: _____________________
Medical History & Current Conditions:
Please provide relevant health information, including previous injuries, chronic conditions, or current medications that may affect yoga practice.
Goals & Expectations:
Describe your goals for yoga therapy and any specific issues you wish to address during sessions.
Lifestyle & Preferences:
Include information about activity level, lifestyle habits, and preferred session times or styles.
Consent & Acknowledgment:
I acknowledge that the information provided is accurate and understand that yoga therapy is a complementary practice. I agree to notify the therapist of any health changes.
Signature: ____________________________
Date: ____________________________
Therapist Notes:
(Space for therapist to record initial assessments, recommendations, and follow-up plans)