Name *

First Name

Last Name

Phone

(###)

###

####

What would you like to focus on? *

Select all that apply

Building a Personal Practice

Chronic Pain

Alignment

Anxiety / Depression

Trauma-Informing Cueing (for teachers)

Sequencing Development (for teachers)

Are you working with any licensed medical professionals currently? *

This includes: therapists, surgeons, psychiatrists, physical therapists, etc...

Yes

No

What is your yoga practice like? *

I've never tried yoga before

I've tried a few times but I am not familiar

I do yoga often

I practice 2-3 times a week and need support/guidance

If Applicable, would you like to plan our sessions together alongside your hormonal (menstural) cycle? *

Pick any option you feel most comfortable with.

Yes

No

Not Applicable

How would you like to meet? *

On Zoom

In Person / In Studio

Zoom / In Studio