top of page
Home
About
Team
Healing
Individual and Couples
Children and Family Therapy
Group Therapy
Scheduling & Inquiry
More
Insurance & Payment
Job Opportunities
Our Office
Activities & Events
Yoga Waiver
Community Resources
Blog
Log In
Client Portal
Before Your Healing Journey Begins...
Please take a moment to review and complete our Yoga Waiver & Informed Consent form.
Yoga Liability Waiver
First name
*
Last name
*
Date of birth
*
Month
Month
Day
Year
Phone
*
Email
*
Multi-line address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
Preferred Contact
*
Phone
Email
Text
How did you hear about us?
*
Friend/Relative
Green City Market
Google, Instagram, Facebook, other online/social channels
Other
Emergency Contact
*
Emergency Contact Phone
*
Next
bottom of page