Yoga Therapy Intake Form

Most yoga therapists require their students to fill out a client intake form before beginning a yoga therapy session. The main goal is to get to know your clients by learning some critical facts about them and giving them a chance to provide crucial information that they might not otherwise be able to (i.e. health conditions, long term goals, etc...).

Although it might seem a little "extra," this is a great chance to find out about any medical issues or personal situations that your students feel might affect their yoga practice. It's also a terrific first step in building trust between you and your clients. So what are the specific questions you should ask on your yoga therapy intake form? Read on to find out.

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What Questions Should You Ask Your New Yoga Therapy Clients?

The specific questions you ask may vary depending on your business requirements but try to keep this form straightforward and focus on establishing a welcome environment for your yoga students making them feel valued from the time they contact you.

Here are some of the vital elements you must make sure to address on your intake form before you start the yoga therapy sessions.

Contact Information

Begin your intake form with the client's basic contact information. Here's what they should provide.

- Full name

- Date of birth

- Phone number (cellphone, work, home phone)

- Emergency contact name and further details (relationship, phone number, address, etc...)

- Billing/physical address

- Insurance information

Practice Experience

It's a great idea to include a set of questions to evaluate your client's previous experience with any other yoga therapist or similar activities. Here are some questions you can include in this section.

- Have you ever done yoga before? If so, when was the last time you practiced?

- How frequently do you practice yoga?

- What yoga styles have you practiced?

- Have you tried any other holistic alternative therapies?

- What do you find is the most challenging about your current practice? (yoga postures, time invested, lack of space, etc...)

Lifestyle

Next, try to get some useful insights on the client's lifestyle and habits. Asking your patient about their routine will help you make simple lifestyle recommendations that might help them live healthier lives. You can include the following inquiries.

- What are your favorite physical activities? What's your least favorite?

- Do you workout on a regular basis? Please explain:

- Describe your sleeping and resting habits. (For example, hours, naps, difficulties getting or keeping asleep)

- What do you eat on a daily basis?

- Do you smoke, drink, or use other recreational drugs?

- Please explain your spiritual beliefs and practices.

- Does your energy change or stay the same throughout the day?

- How much caffeine do you take in each day?

Physical Health History

Some yoga postures might be contraindicated under certain medical conditions, so it's important that your client is open and honest about their health history including surgeries, treatments, diagnosis etc. Remind your client that the yoga therapy does not substitute medical examination and they should always seek their primary physician for such service.

Try including some of the following questions to gather more vital information.

- Describe the places of your body that are uncomfortable or painful. Try to describe their location as well as the type/degree of discomfort.

- What functional movements or tasks are you finding difficult? (standing, bending, sitting for long periods, etc...)

- What other healthcare professionals are you seeing for your health concerns or overall well-being? How frequently do you see them?

- Make a list of your current and former medical issues. Include medical diagnoses, operations, accidents, injuries, and so on, as well as approximate dates.

- Do you take pain relievers?

- Are there any serious injuries or hospitalizations that you have had in the past, even if you are not now experiencing symptoms?

- Do you have any other conditions or injuries that you have not yet discussed? (depression, cancer,

Goals and Expectations

Last but not least, include a set of questions to help you ensure the services you provide are appropriate for the client and that you fully understand what outcomes they are expecting to get out of the treatment.

- Why are you seeking yoga therapy?

- Considering your time limitations, what amount of time (daily, weekly or monthly) can you reasonably invest in this yoga therapy?

- What objectives do you hope to achieve through yoga therapy? (flexibility, balance, stress/anxiety reduction, muscular tension relief, etc...)

- What are your current life challenges?

- What areas of your life bring you the most happiness and pleasure?

- What would you change now, if you had the power to?

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