Private Sessions Questionnaire

Please fill out the following information so I can better serve your needs.

Name *
Enter numbers only
Phone *
What topics interest you? *
Please check all that apply
Do you currently have or have you had any of the following:
Please check all that apply:
If not, please contact your medical professional for clearance.
Are you comfortable with hands-on physical assists?
Example: light hands-on pressure in poses
(1 being very poor physical fitness and 10 being optimal physical health)
(1 being not stressed at anytime and 10 being extremely stressed constantly)
Dogs, essentials oils, etc.