serving binghamton, johnson city & Vestal Yoga Body Shop Questionnaire Email Address* Name* First Last Phone*How did you hear about us?* Google Facebook Instagram In the neighborhood From a friend I'm a current member YBS Email/Newsletter Other Look back over your life and please describe the best you’ve ever felt... What were you doing then and who were you doing it with?*What are your specific health, wellness, and lifestyle goals?*What are you doing right now to achieve these goals?*How long do you realistically think it will take to achieve the goals you have in your mind?* 30 Days 1-3 Months 3-6 Months 6-12 Months 12+ Months Historically, what has triggered you to stop your efforts to reach your goals? (this helps us to prevent the same trigger in the future)*Everyone has something that has the potential to derail their efforts. What obstacles do you foresee standing in your way?* Stress Time/Scheduling Budget Support System Skill/Knowledge Other How often would you like to come to Yoga Body Shop to work on your wellness goals?* 1 day per week 2 day per week 3-5 day per week As much as possible Only 1-2 times per month or less Have not decided yet Other Are you a(n):* Early Bird (6am) Mid Morning Enthusiast (9:30 am) Lunch Time Refresher (12 noon) Early Evening Enthusiast (4 pm) Late Evening (5:30-7:30 pm) Weekend Warrior Other Do you have aches or pains in any parts of your body? Any Injuries that you're working to heal in your classes with us?*Just one last question, if you can imagine what your life will look like when you achieve your aforementioned goals, how will you feel? How will your life change? What will you do?*Do you need more support or have any questions about your yoga practice?*Would you like to meet with a staff member to assist you further? Yes No
