Yoga Intake Form · Light and Balance

About you

First name *

Last name *

Date of birth *

Email *

Phone *

City & Province / Country *

How did you hear about Light & Balance?

I'd like to receive occasional news and updates from Light & Balance

Health & physical history

Physical & mental health history *

Please include any significant conditions, injuries, physical limitations, or anything relevant to movement and yoga practice.

Current treatments

Are you currently receiving any medical, physiotherapy, or other care? If yes, please describe.

Yoga experience

How would you describe your yoga knowledge and experience — complete beginner, occasional practitioner, regular student?

Exercise habits

Do you exercise? If so, what type and how often?

Session preferences

Hands-on adjustments *

Yoga instruction can involve light touch to assist with alignment — this is not massage. You can always change your preference during the session.

Yes, I'm comfortable with light hands-on adjustments Verbal guidance only — please no touch Not sure — I'd like to discuss at the start of the session

Positioning *

Do you have any difficulty lying on your front, back, or sides? Any positions to avoid?

Sensitivities *

Any allergies, food intolerances, or environmental sensitivities (e.g. scents, incense) I should be aware of?

Equipment *

I will bring my own yoga mat and props I'll need to borrow a mat and/or props — please let me know what's available

Group registration

Are you the primary registrant, or part of a group? If joining with others, please list their names here.

What would you like to get out of our sessions? *

e.g. flexibility, stress relief, strength, energetic awareness, learning the basics, etc.

Terms & policies

Yoga Terms & Conditions

Sessions are tailored to your individual needs and level. Please communicate openly about discomfort or limitations at any time.
While yoga can support many physical and emotional conditions, I am not a physiotherapist and cannot treat, diagnose, or prescribe for medical injuries or conditions.
Please continue to receive appropriate medical care for any health concerns.
All information shared is held in the strictest confidence, except as required by law or in situations of credible risk of harm.
Please arrive 10 minutes early for in-person sessions. Sessions will not be extended for late arrivals.
If you arrive more than 15 minutes late, the appointment may need to be rescheduled and the full fee will apply.

Do you understand and agree to the above? *

I agree I do not agree

Cancellation & Refund Policy

Please give at least 24 hours notice to cancel or reschedule.
Sessions cancelled with less than 24 hours notice, or missed without notice, will be charged the full session fee.
There are no refunds on sessions already provided.

Do you understand and agree to the above? *

I agree I do not agree

Liability Disclaimer

I hereby release Maria Petropoulos and Light and Balance Reiki and Yoga from all liability arising out of any reliance upon advice or information given during sessions, now or in the future. I assume all risks and responsibilities for my participation and release Maria Petropoulos and Light and Balance Reiki and Yoga from any injury or liability that may occur during a session. I confirm that I have disclosed all relevant physical and health information above.

Do you understand and agree to the above? *

I agree I do not agree

By submitting this form you confirm all information is accurate to the best of your knowledge. Maria will be in touch to confirm your session details and answer any questions.

Thank you ✦

Your intake form has been received. Maria will be in touch shortly to confirm your session details. We look forward to practising together.