Private Client Intake From Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM DD YYYY Email * Contact Number * Country (###) ### #### Emergency Contact Number * Country (###) ### #### Have you practised any forms of yoga, meditation or breathwork before? * What styles of yoga and healing modalities are you interested in exploring? * Breathwork Meditation Vinyasa / Flow Yoga Kundalini Yoga Yin / Restorative Yoga Do you prefer a more dynamic or gentle practice? * Dynamic Gentle What are your main goals for our sessions? (e.g., emotional release, stress relief, flexibility, strength, meditation, or other - please specify) * Are there any specific areas you would like to focus on? (e.g., mindfulness, back pain, hip flexibility etc.) * Do you have any current or past injuries or conditions I should know about? (please specify) * Which length of session would you like? * 50min - £120 75min - £180 Preferred date for first session: MM DD YYYY General Availability Please share days/times of the week that may be possible for sessions so if your preffered date isn't available I can suggest alternatives that may suit Would you like your session from home or at Inner Landing? * Inner Landing is located at 16 Wotton Road, NW2 6PX At home session Inner Landing session Please share anything else that will help me prepare for our time together: I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in this session. * I agree Thank you! I will be in touch soon to confirm your session. Warm wishes,Rebecca