Patty Grant – Yoga Therapy Tools to build a strong foundation

Please bring this form with you to your appointment. Please take a moment to read the cancellation policy on the last page.

Name: ________________________________ Date: _______________________________

Address: _______________________________________________________________________

Contact Number: ___________________________ Emergency Contact__________________________

E-Mail: ___________________________________ D.O.B. ____________________________________

How did you hear about my Yoga Therapy services? ______________________________________

THE FOLLOWING QUESTIONS WILL HELP ME PROVIDE THE BEST YOGA THERAPY EXPERIENCE FOR YOU.

What is your primary or secondary reason for booking this session?

Please let me know of any past or current medical concerns or health conditions. For example: low or high blood pressure, diabetes, cardiovascular disease, osteoporosis, detached retina, glaucoma, carpal tunnel syndrome, past rotator cuff injury, back pain or strain, recent surgeries and anything else you feel I need to know.

Please list any past or current treatments you are receiving. For example: massage, cranial sacral therapy, acupuncture, chiropractic care, medical treatment, TMJ treatment etc…

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Please list your medications and/or herbal supplements and the purpose of each.

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Patty GrantCertified Yoga InstructorAFLCA Certified Fitness Leader/Assistant TrainerPgrant1@telus.net663 Chaparral Drive S.E.403-990-9026

What physical activities do you participate in?

How would you describe your life? What are you working on? What is your focus?

What is your biggest challenge right now?

What do you hope to gain by practicing yoga/movement therapy?

Is there anything else I should know to help you achieve your goals?

To help you prepare for your session I have listed some information on what you can expect and how you can prepare…

Please wear light comfortable clothing that is somewhat fitted. Bring a water bottle so that you may hydrate after your session. Please arrive on time. Your session begins at the time agreed upon at the time of

booking. You may bring your own yoga mat or one may be provided for you. Please bring this form with you to your first session. You will fill out a waiver when you arrive.

Some guiding principles I use are:o Less is moreo Relaxation is nourished and supportedo The Spine is important and connects with the entire bodyo Move the largest joints firsto Move joints in their optimum range of motiono Breathe and become awareo Be kind to yourself and move in your pain free, strain free range of motiono The core is developed by moving purelyo You will be given tools to help build a strong, healthy foundation, which may include

exercises in breathing or movement.

CANCELLATION POLICY: 48hrs notice is required otherwise the session will be charged at the per session rate.

Tools to build a strong foundation.