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Yoga Booking Form

*First name

*Last name

*Email

*Phone

SECTION 2: Booking Preferences

*What type of yoga session are you booking?

Private Session

Group Class

Corporate Wellness

Nervous System Regulation Session

Breathwork & Mobility

Restorative Yoga

Beginner Yoga

*Preferred Session Format

In-person

Online

Either

Have you practiced yoga before?

Yes

If yes, how would you describe your experience level?

SECTION 3: Health & Physical Awareness

*Do you currently experience any of the following?

Back pain

Neck tension

Migraines/headaches

Anxiety/stress

Fatigue/burnout

High blood pressure

Low blood pressure

Joint pain

Pregnancy

Recent surgery

Injury or limited mobility

Heart conditions

Stomach

Gastric problems

None

Please share any injuries, limitations, or concerns we should know about before your session

Are you currently under medical care for any physical condition?

Yes

If yes, please briefly explain

please include a note on any allergies we should be aware of.

For the Ladies: Menstruation

Regular

Irregular

Backache before/ during

Discomfort experienced before / during

SECTION 4: Intentions

What are you hoping to receive from this experience?

Stress relief

Emotional grounding

Improved flexibility

Better sleep

Nervous system regulation

Energy balance

Strength & mobility

Mindfulness

Team connection

General wellbeing

SECTION 5: Consent & Policies

I understand that yoga and breathwork practices are supportive wellness modalities and are not a substitute for medical or psychological treatment.

I understand that participation is voluntary and I will listen to my body throughout the session.

I agree to the cancellation and rescheduling policy.

I consent to my information being stored securely in accordance with POPIA regulations.

LET'S CONNECT

WhatsApp: +27 82 936 0582

Email: shenbuckus@gmail.com

QUICK LINKS

SERVICES

Crystal Healing Therapy

Corporate Wellness

JOHANNESBURG | PRETORIA

Terms and Conditions

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