New Clients | Denver

The form on this page should only be completed if you have been directed to do so by a member of the WellStated Team. If you are interested in joining one of our programs but have not yet spoken with one of our associates, please contact us first for a free consultation by visiting the Contact Us page.

WellStated Workshop Intake Form

Please note that all information on this form is strictly for the purpose of customized workshop formation and nothing else. All information will remain completely confidential. Your answers are used to find commonalities (and differences) to create a completely customized program with your needs at the heart of the program. With detailed and honest answers, WellStated is able to create a platform in which you are more likely to connect to, from a very authentic place. We strive for each program to be genuine, relatable and to meet your specific needs on an inspirational level. To quote Jerry McGuire, “Help me, help you!”

Your Yoga Practice

Why are you interested in group wellness workshops?

What inspires you?

In regards to your own personal development, how are you currently growing?

What might you like to work on?

Do you have a current yoga or meditation practice?

How long have you been practicing yoga and meditation?

Please provide a description of your daily yoga practice. Which postures do you practice during a typical session? Do you meditate? Do you practice pranayama? How long is your typical meditation sit?

What is your favorite style of yoga to practice and why is it your favorite?

What is most important to you in your yoga practice?

Do you consider yourself to be a Type A personality (achievement driven, competitive, prefer a fast pace, prefer feel in charge), or a Type B personality (generally more relaxed, go with the flow, enjoy the journey, value the process over the outcome), or somewhere in between (if so, which do you traits do you identify with)? AND Why?

Have you ever felt "in the zone?" Please describe the circumstances and how you felt.

What kind of music do you like to listen to? (Genres and specifics please!)

General Health Information

Do you have any injuries? If so, when did your injury occur?

How did you injure yourself?

What area of your body is affected by your injury?

What activities relieve your pain/discomfort?

What activities of daily living (i.e., dressing, bathing, cooking, cleaning, walking) are you unable to do because of any injury or pain?

What activities do you participate in for exercise and enjoyment?

Have you received physical therapy in the past for an injury? (Yes or No)

Are you, or have you been under medical treatment for any physical or psychological condition?

Are you currently pregnant or trying to get pregnant?

Please discuss with the Teacher any medical condition that might affect your

participating in the Activities. All information that you provide to Teacher in this input form or otherwise will be held strictly confidential.

Thank you for submitting your information! We will be in touch with you soon regarding next steps. If you do not hear from us within the next 72 hours, please call us at the number on the Contact Us page.