Registration for 40 Day At-Home Yoga Program Name(required) Email(required) Do you have any physical injuries or ailments that will impact your yoga/meditation practice? If so, please describe.(required) Describe your existing meditation/yoga practice (if any).(required) Describe your yoga/meditation goals. Please give as much detail as possible.(required) Please describe any barriers or issues that have historically prevented you from reaching your meditation/yoga goals.(required) Please rate your daily level of stress (1=almost no stress, 10=incredibly stressed)(required) Please describe how well you sleep on any given week (e.g. “ I sleep well most nights but restlessly due to anxious thoughts about once a week” etc.). If you use sleeping aids (prescription or otherwise) please describe.(required) How is your daily energy level? Do you feel you have enough energy each day?(required) Generally describe your diet and specifically list out what you eat in a typical day.(required) Please describe your beverage consumption and what you drink over the course of a day (how much tea, coffee, soda, water, alcohol).(required) In the past have you found change difficult, easy, or somewhere in between for you (this includes schedule changes, lifestyle changes, etc.)? Please feel free to elaborate if appropriate.(required) Do you have an easy, moderate, or difficult time with follow through (ability to commit to a course of action and stick with it)? Please feel free to elaborate if appropriate.(required) What is the maximum amount of time you can commit to this practice each day?(required) What is the minimum amount of time you will commit to this practice each day?(required) Please feel free to add any additional comments that will help us determine an appropriate program for you. If you are on prescription medication that may impact your meditation, please describe here. Please include any background information that might be helpful for us in assigning you a program.(required) Submit Δ
