New Client Form

Thank you for taking the time to fill this out! It will help me create sessions for your specific needs, goals and body from our first meeting. If you prefer, we can review this in person at our first session. I will provide necessary yoga props, however, please let me know if you will need to borrow a yoga mat.

If you have any questions, please email me at or call at 415-517-5089.

Name *
Location for yoga sessions
Phone *
Date of Birth *
Date of Birth
Examples of styles are Hatha (holding postures without flow. Ex. Iyengar), Vinyasa (flowing through a yoga sequence), Kundalini, Yin, Restorative, etc. If you're not sure that's fine!
What are your session goals/ expectations?
Check all that apply
Aspects of the practice you are interested in focusing on in our work together:
Check all that apply
Would you like to receive my periodic eNewsletter?
Please check below to agree that you understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. I will continue to breathe smoothly. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Charlotte von Hemert.