Yoga and Pilates Class Registration

I. Personal Information

First Name

Last Name

Date of Birth

Contact Information

Phone Number

Email Address

Street Address

City

State/Province

Postal/Zip Code

Emergency Contact

First Name

Last Name

Phone Number

II. Health and Fitness Background

What is your primary reason for seeking Yoga and/or Pilates coaching?

Stress relief

Improved flexibility

Strength building

Injury rehabilitation

Weight management

Posture improvement

General fitness

Other (please specify):

Do you have any previous experience with Yoga or Pilates?

If yes, please describe:

What is your current level of physical activity?

Sedentary

Light activity (e.g., walking, light stretching)

Moderate activity (e.g., gym, swimming, cycling)

High activity (e.g., running, weightlifting, competitive sports)

Other (please specify):

Do you have any medical conditions, injuries, or physical limitations that we should be aware of?

If yes, please list:

Are you currently under the care of a healthcare provider?

If yes, please describe:

Are you currently under the care of a physician or physical therapist?

If yes, please provide details:

Have you been diagnosed with any of the following?

High blood pressure

Heart conditions

Diabetes

Osteoporosis

Joint or back pain

Other (please specify):

Are you pregnant or postpartum?

If yes, please specify trimester or postpartum timeline:

Do you have any allergies or sensitivities?

If yes, please specify:

Are you currently taking any medications?

If yes, please list:

III. Goals and Preferences

What are your specific goals for Yoga and/or Pilates coaching?

Improve flexibility

Build core strength

Reduce stress and anxiety

Enhance balance and coordination

Recover from injury

Improve posture

Increase overall fitness

Other (please specify):

How soon would you like to achieve these goals?

1-3 months

3-6 months

6-12 months

Ongoing maintenance

What is your preferred coaching format?

Individual coaching (one-on-one sessions)

Group coaching (small or large group sessions)

A combination of both

What is your preferred session duration?

30 minutes

45 minutes

60 minutes

90 minutes

What is your preferred time of day for sessions?

Morning

Afternoon

Evening

Do you have any preferences for the style of Yoga or Pilates?

 

Yoga Styles:

Hatha

Vinyasa

Ashtanga

Yin

Restorative

Kundalini

Other (please specify):

Pilates Styles:

Mat Pilates

Reformer Pilates

Clinical Pilates

Other (please specify):

Do you have access to any equipment for home practice?

Yoga mat

Pilates ring

Resistance bands

Dumbbells

Reformer machine

Other (please specify):

IV. Lifestyle and Habits

How would you describe your stress levels?

Low

Moderate

High

How many hours of sleep do you get per night on average?

Less than 5 hours

5-7 hours

7-9 hours

More than 9 hours

What is your typical diet like?

Balanced and healthy

Vegetarian/Vegan

High in processed foods

Other (please specify):

Do you consume alcohol or smoke?

If yes, please specify frequency:

V. Consent and Agreement

I understand that Yoga and Pilates involve physical activity and that I should consult my physician before beginning any new exercise program.

I agree to inform my coach of any changes in my health or medical condition.

I understand that my coach is not a medical professional and that any advice given is not a substitute for medical care.

I consent to the use of my personal information for the purpose of designing a personalized coaching program.

VI. Services Offered

Please select the services you are interested in:

 

Individual Coaching:

One-on-one Yoga sessions

One-on-one Pilates sessions

Customized Yoga and Pilates programs

Injury rehabilitation coaching

Group Coaching:

Small group Yoga classes (up to 5 participants)

Large group Yoga classes (6+ participants)

Small group Pilates classes (up to 5 participants)

Large group Pilates classes (6+ participants)

Workshops and retreats

Additional Services:

Nutritional guidance

Mindfulness and meditation coaching

Progress tracking and assessments

Online coaching and virtual sessions

VII. Client Signature

By signing below, I confirm that the information provided in this form is accurate to the best of my knowledge.

I understand the nature of the services being offered and agree to participate at my own risk.

Signature:

Client Intake Form Insights

Please remove this client intake form insights section before publishing.


Below is a detailed insight into this Client Intake Form, explaining the purpose and importance of each section, as well as how it helps both the client and the coach establish a productive and safe coaching relationship.

1. Client Information

This section collects basic personal details about the client.

  • Purpose:
    To establish clear communication channels (email, phone, etc.).
    To ensure the coach has emergency contact information in case of an incident during a session.
    To personalize the coaching experience by addressing the client by name and tailoring communication.

2. Health and Fitness Background

This section is critical for understanding the client's physical condition, medical history, and any limitations that may affect their participation in Yoga or Pilates.

  • Purpose:
    To identify any medical conditions, injuries, or physical limitations that may require modifications to exercises or special attention.
    To ensure the client is physically cleared to participate in Yoga or Pilates (e.g., consulting a physician if necessary).
    To tailor the program to the client's fitness level and avoid overexertion or injury.
    To accommodate pregnant or postpartum clients with appropriate modifications.

3. Goals and Preferences

This section helps the coach understand the client's motivations, expectations, and preferences for the coaching program.

  • Purpose:
    To align the coaching program with the client's specific goals (e.g., stress relief, flexibility, strength building).
    To determine the client's preferred coaching format (individual vs. group) and session duration, ensuring the program fits their lifestyle.
    To identify the client's preferred styles of Yoga or Pilates, which helps in designing a program they will enjoy and stick to.
    To assess whether the client has access to equipment for home practice, which can influence the design of the program.

4. Lifestyle and Habits

This section provides insight into the client's daily habits, stress levels, and overall lifestyle.

  • Purpose:
    To understand factors that may impact the client's ability to achieve their goals (e.g., high stress levels, poor sleep, or unhealthy diet).
    To identify areas where the coach can offer additional support, such as mindfulness practices or nutritional guidance.
    To assess whether the client's lifestyle aligns with their stated goals and to provide recommendations for improvement if needed.

5. Consent and Agreement

This section ensures the client understands the nature of the services being offered and acknowledges their responsibility for their own health and safety.

  • Purpose:
    To inform the client that Yoga and Pilates involve physical activity and that they should consult a physician if necessary.
    To establish clear boundaries regarding the coach's role (e.g., not providing medical advice).
    To obtain the client's consent to use their personal information for program design and progress tracking.
    To protect both the client and the coach by ensuring the client understands the risks and responsibilities involved.

6. Services Offered

This section outlines the available coaching options and allows the client to select the services they are interested in.

  • Purpose:
    To provide a clear overview of the services available, including individual coaching, group classes, and additional offerings like nutritional guidance or mindfulness coaching.
    To help the client choose the format and style that best suits their needs and preferences.
    To set expectations for what the coaching program will include.

7. Client Signature

This section formalizes the client's agreement to the terms outlined in the form.

  • Purpose:
    To confirm that the client has provided accurate information and understands the nature of the services.
    To create a legal record of the client's consent and acknowledgment of risks.

How This Form Benefits the Client

  1. Personalized Program: The form ensures the coaching program is tailored to the client's goals, preferences, and physical condition.
  2. Safety: By identifying medical conditions, injuries, and limitations, the coach can design a program that minimizes the risk of injury.
  3. Clarity: The form sets clear expectations for the coaching relationship, including the services offered and the client's responsibilities.
  4. Accountability: By documenting the client's goals and preferences, the form helps keep the coaching program focused and aligned with the client's objectives.

How This Form Benefits the Coach

  1. Risk Management: The form helps the coach identify potential risks (e.g., medical conditions) and take appropriate precautions.
  2. Program Design: The information collected allows the coach to design a program that is effective, enjoyable, and safe for the client.
  3. Professionalism: The form demonstrates the coach's commitment to providing a structured and professional service.
  4. Legal Protection: The consent and agreement section protects the coach from liability by ensuring the client understands the risks involved.

Key Considerations for the Coach

  • Confidentiality: Ensure the client's personal and medical information is stored securely and used only for the purpose of designing their coaching program.
  • Follow-Up: If the client indicates any medical conditions or injuries, follow up with additional questions or recommend they consult a physician before beginning the program.
  • Flexibility: Be prepared to adapt the program based on the client's feedback and progress over time.

This Yoga and Pilates Coaching Client Intake Form is a comprehensive tool that ensures the coaching relationship is built on a foundation of trust, safety, and mutual understanding. It empowers the client to take an active role in their wellness journey while providing the coach with the information needed to deliver a high-quality, personalized experience.


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