Private Session Intake Form - Tidal Yoga

Skip to content

HOME
CLASSES & PRICING
PRIVATE SESSION
STUDIO & FAQ
- About Tidal Yoga
- Studio Etiquette & FAQ
CONTACT
BOOK NOW

Private Session Intake Formscott2025-06-12T00:26:54+00:00

Private Session Intake Form

General Information

Full Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Phone(Required)

Email(Required)

Emergency Contact Name(Required)

Emergency Contact Number

Preferred Session Type(Required)

In-Studio

In-Home

Health History

Please check/circle any that apply

(if it applies, please explain below)

Recent injury (within 12 months)

Chronic pain

Surgeries (past or upcoming)

Joint instability or hypermobility

Back, neck, or shoulder issues

Hip, knee, or ankle concerns

Pregnancy / Postnatal

Neurological or autoimmune conditions

Cardiovascular or respiratory issues

Broken bones — if yes, where:

Muscle strains or sprains

Frequent or recurring headaches

Other (please describe):

Recent injury (within 12 months). Where?(Required)

Chronic pain(Required)

Surgeries (past or upcoming)(Required)

Joint instability or hypermobility(Required)

Back, neck, or shoulder issues(Required)

Hip, knee, or ankle concerns(Required)

Broken bones(Required)

Muscle strains or sprains(Required)

Other(Required)

If any of the above need additional explanation, please use space below:

Are you currently experiencing any of the following?

Pain

Tightness

Limited mobility

Pain(Required)

Tightness(Required)

Limited mobility(Required)

If any of the above need additional explanation, please use space below:

Are you currently under the care of a physician or physical therapist?(Required)

Yes

No

Please explain(Required)

Are there any movements or positions that cause discomfort or pain?(Required)

Yes

No

Please explain(Required)

Movement Goals & Preferences

What are your goals for private sessions? (Check all that apply)

Reduce pain or discomfort

Increase mobility or flexibility

Build strength

Improve posture or alignment

Improve body awareness / mind-body connection

Learn more about muscle activation techniques

Reduce stress / relax

Recover from injury or surgery

Improve balance and coordination

Increase confidence in movement

Prepare for returning to group classes

Other

Please explain(Required)

Do you have prior experience with yoga?

Yes

No

What style(s) and for how long?(Required)

Are there any specific areas of the body you'd like to focus on?(Required)

Yes

No

Please explain(Required)

What pace of session do you prefer?(Required)

Slow & Restorative

Moderate & Focused

Strong & Engaging

Would you like to incorporate journaling or reflection prompts?(Required)

Yes

No

Are you comfortable with hands-on assists or gentle tactile cueing?(Required)

Yes

No

Please discuss with me first

Do you have any questions, concerns, or anything else you'd like your instructor to know?(Required)

Yes

No

Please explain(Required)

Props & Setup (for private sessions only)

Do you have your own yoga mat?(Required)

Yes

No

Do you have any props? (Check all that apply)(Required)

Blocks

Strap

Resistance Bands

3 lb Free Weights

Yoga Blanket or Small Rollable Blanket

None

By submitting this form, I affirm that the information I’ve provided is accurate to the best of my knowledge. I understand that this information will be used to tailor my private session and that I may update it at any time.(Required)

Confirm

Δ

SEE STUDIO FAQ & WHAT TO EXPECT

Tidal Yoga Siesta Key

Tidal Yoga | 5212-1/2 Ocean Blvd Ste 4, Siesta Key, FL 34242 | (941) 207-5001

©2026 Copyright Tidal Yoga | Siesta Key, FL. All rights reserved. | Web Development by CMD Graphics