Head & Heart Yoga for Mental Health

Name*

Phone Number*

Email*

How did you hear about Head & Heart Yoga?*

Are you interested in Head & Heart Yoga for yourself or someone else?*

How old is the participant?*

What brings you to Head and Heart Yoga?*

What mental health concerns are you looking to address through the practice of yoga?*

What is your level of experience with yoga (novice, some experience, intermediate, advanced)?*

Are you currently experiencing thoughts about hurting or killing yourself? Or have you experienced these thoughts in the past?*

Do you currently have any medical conditions, chronic pain, or injuries that may impact your practice?*

Have you experienced a traumatic event? (e.g. medical trauma, sexual trauma, domestic violence)*

What would you like to get out of your experience in yoga?*

Wayne, PA

More than just psychotherapy : enriching your mind, body, life