First Name
Last Name
Date of Birth
Phone Number
Email Address
Street Address
City
State/Province
Postal/Zip Code
First Name
Last Name
Phone Number
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?
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?
Are you currently under the care of a healthcare provider?
Are you currently under the care of a physician or physical therapist?
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?
Do you have any allergies or sensitivities?
Are you currently taking any medications?
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):
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?
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.
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
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.
This section collects basic personal details about the client.
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.
This section helps the coach understand the client's motivations, expectations, and preferences for the coaching program.
This section provides insight into the client's daily habits, stress levels, and overall lifestyle.
This section ensures the client understands the nature of the services being offered and acknowledges their responsibility for their own health and safety.
This section outlines the available coaching options and allows the client to select the services they are interested in.
This section formalizes the client's agreement to the terms outlined in the form.
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.