New Yoga Client Intake Form

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Name *

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Last

Address *

City, State, Zip *

Phone Number *

Email *

Birthday *

How did you hear about us? *

If you were referred to us, by who? *

If other, please explain: *

Yoga can be therapeutic and provide many health but there are some yoga poses that are not appropriate for certain people. Any health program, have medical concerns you should consult with your doctor to find out limitations you may have in your yoga practice.

Please read the following carefully and check the boxes to indicate that you understand our policies. If you have any questions, please contact us at (618) 207-4404.

While we provide you with he alignment principles for you to practice and progressed safely under normal conditions, ultimately you are responsible for your own safe yoga practice. *

I have informed Oasis of any injuries or health issues.

First and Last Name: *

Today's Date: *

By completing and submitting this form you agree to the terms and conditions.

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Contact Information
Oasis Skin & Wellness Clinic Inc.
707 Walnut St
Murphysboro, IL 62966
info@oasisskincareclinic.net
Call or Text (618) 207 - 4404

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