✨ Signature Flow Yoga Intake Form ✨

I'm so excited you're here! This form helps me get to know you better so I can create a yoga experience that truly fits you. Your answers will help establish a foundation for a practice that feels just right—aligned with your goals, lifestyle, and preferences. Ready? Let's get started!

First name

Last name

Phone

Birthday

Month

Day

Year

How would you describe your yoga experience?

What are your primary reasons for practicing (or wanting to practice) yoga? *Pick your top 2-3

Any areas of the body you'd like to focus on? (e.g., hips, shoulders, back, core, legs, etc.) If nothing specific, write "full body."

Do you have any injuries, sensitivities, or medical conditions I should be aware of? (if yes, please describe; if none, write NA)

How long do you want your signature yoga flow to be?

How often do you plan to practice your signature flow?

Where do you plan to practice your signature flow? (e.g., home, outdoors, gym, studio, etc.)

What yoga equipment do you own already and/or plan to purchase?

Yoga mat

Yoga blocks (2)

Yoga bolster/pillow

Heavy blanket

How do you want to feel after your yoga session? (Describe in a few words—e.g., calm, strong, balanced, inspired, etc.)

What specific yoga poses do you LOVE and would like to incorporate if possible? If nothing comes to mind, write "not sure."

What specific yoga poses would you rather omit from your practice? If nothing comes to mind, write "not sure."

Anything else you'd like to share to make this practice feel truly yours?

Yoga Waiver & Informed Consent

I acknowledge that I am voluntarily participating in yoga sessions led by Kelly Mortensen. I understand that yoga involves physical movement, breathwork, and relaxation techniques, which may include stretching, strengthening, and balance exercises. As with any physical activity, I recognize that there is an inherent risk of injury, including but not limited to muscle soreness, strains, sprains, and, in rare cases, more serious injuries.

I affirm that I am physically fit and have no medical conditions that would prevent my full participation in yoga. I agree to listen to my body, modify movements as needed, and seek medical advice if I have any concerns about my ability to participate. I understand that the instructor is not a medical professional and that yoga is not a substitute for medical advice, diagnosis, or treatment.

By signing this waiver, I assume full responsibility for any risks, injuries, or damages that may occur as a result of my participation. I hereby release, waive, and discharge Kelly Mortensen, State of Flow Wellness from any and all claims, liabilities, or demands arising from my participation in yoga sessions and/or programs.

I have read and fully understand this waiver, and I voluntarily agree to its terms.

Signature

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