Pregnancy Yoga Intake Form
Please complete this form so we can understand your needs, preferences, and any practice considerations before class.
Participant Details
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone
Text Message
Pregnancy and Practice Information
Current pregnancy stage
*
Please Select
First trimester
Second trimester
Third trimester
Expected due date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current yoga experience level
*
Beginner
Some experience
Regular practitioner
Preferred or avoided yoga styles / class formats
Gentle flow
Restorative
Prenatal yoga
Hatha
Vinyasa
Breathwork focus
Meditation focus
Chair-based
One-on-one
Small group
Avoid inversions
Avoid strong twists
Avoid hot classes
Other
Health and Safety Notes
Relevant physical limitations, discomforts, injuries, or modifications
Emergency contact name
*
First Name
Middle Name
Last Name
Emergency contact phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Confirmation
*
I understand to practice within my own comfort level and inform the instructor of any changes or concerns during class.
Submit
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