Adventures in Soulitude intake form

Adventures in Soulitude

Intake form

Start your journey to Soulitude

In order for me to provide the most nourishing and personalized yoga class that I can, please take some time to answer the following questions.

The more information you can provide, the better able I will be to address the personalized needs of your body, mind and energy.

Your answers will be kept strictly confidential.

Georgia Cyr programs in Sunshine Coast BC

Please complete the following intake form.

Your name

Your email

Is this for an individual or a group?


What is your experience level with yoga?

Beginner (0-3 years of practice)Intermediate (4-8 years of practice)Advanced (9+ years of practice)

What would you most like to accomplish through your yoga practice? (check all that apply)

Muscle strengtheningFlexibilityJoint stabilityImprove postureImprove sleepRelieve StressGrow spirituallyIncrease body awarenessImprove breathingDeepen my practice and learn more about the posesI am new to yoga and want to practice in a one-on-one, comfortable environmentAddress a specific injury or ailmentIncrease my athletic performanceSpend quality time with a family member or friendOffer a health-minded gift to my client(s)/employee(s)Other

If you selected other, please specify:

Is there a specific style of yoga you are interested in?

Restorative (slow, healing practice, each pose held for 10-15 minutes, requires props)Yin (slow practice, focusing on joint mobility, each pose held for 3-5 minutes)Hatha (a flow of movement, united with the breath, focusing on stretching the muscles)Energizing Hatha (a flow of movement, united with the breath, more vigorous, including more standing & balancing postures & more strengthening)Any of the abovePrenatal (for pregnant women)

Are you interested in incorporating breath work, meditation or mantra (repetition of sound) into your yoga practice?

Yes, breathwork.Yes, meditation.Yes, mantra.None of the above.

How long would you like your personalized class to be?

20 minutes30 minutes45 minutes60 minutes75 minutes

Which of the following are you interested in?

One-off – one practice, pre-recorded and emailedMonthly subscription – one class/month, minimum six month commitment

Do you have, or have you had, any of the following?

High blood pressureOsteoporosisArthritisDizziness, vertigo, or loss of balanceHeadachesDigestive problems

Do you have any physical challenges, previous injuries, or health concerns I should be aware of? If yes, please describe your injury/ailment with as much detail as possible:

Are there are any specific areas of the body you want to focus on or any specific poses you would like to explore:

Do you have any yoga props? If so, what kind and how many? (blocks, bolsters, mat, strap, blankets etc)

Is there anything else you would like me to know, before I create your personalized practice?

Thank you!