Heidi Kolanko Yoga

Name *

First Name

Last Name

Phone Number

(###)

###

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Which best describes your Yoga experience?

Never practiced before

Regular / consistent

Not very often

What do you hope to achieve by practicing Yoga?

Select all that apply.

Coping with stress

Physical benefits (strength & flexibility)

Meditation & Restorative

Overall health & wellbeing

Other

Will this take place at your space or do you need a space provided?

I have a space

I need a space provided

Do you have any physical pain, stiffness, or injuries (past or present)?

Yes

No

What kind of activities do you regularly participate in?

Select all that apply.

Walking

Running

Cycling

Swimming

Weight Training

CrossFit

Yoga

Pilates

Rock Climbing

Surfing

Paddle Boarding

Other