Client Intake Form

Name(Required)

First Last

Email(Required)

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Age(Required)

Do you have any prior yoga experience?(Required)

What is your relationship with fertility? (Kindly respond to any of the following questions to the best of your ability and within your comfort level)(Required)

Are you currently on a family-building journey, or plan to be?

Do you have any known menstrual anomalies you'd like me to be aware of (endometriosis, uterine fibroids, PCOS)? If yes, are you currently seeking treatment?

Are you currently or have you in the past received treatment related to infertility?

Tell me more about why you're here and your interest in Fertility Yoga!

Tell me one fun fact or something that you love about yourself 🙂(Required)

When is the best time to connect with you for a brief consultation?(Required)

How did you hear about Julie C. Yoga?

Please follow the link below to review the Assumption of Risk and Waiver of Liability Relating to COVID-19.(Required)

I acknowledge that I have read and understand the waiver associated with any and all practices with Julie C. Yoga.

Click Here to Review the Waiver