Ricky Tran Yogi for Hire
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SCHEDULE WITH ME
Testimonials
Policies are the same as the initial questionnaire. Refer to this
page
.
This one is shorter.
Just fill out the required fields and any changes that are applicable.
I have read and agree to the policies above.
*
Yes
Personal info
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Indicates required field
Name
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First
Last
Email
*
Re-enter Email
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Phone Number
*
Re-enter Phone Number
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Occupation
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Weight (lbs)
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Height (feet, inches)
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Emergency Contact
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First
Last
Emergency Contact Phone Number
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Emergency Contact Relationship
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Diet & Lifestyle
How many times do you eat per day?
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1
2
3
4
5
5+
What are the sizes of your meals?
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I stop when my stomach is less than 1/2 full.
I stop when my stomach is 1/2 full.
I stop when my stomach is 100% full.
I eat until I have to unbutton my pants.
Please describe your weekly diet in terms of meat, seafood, dairy, fruits, vegetables, grains, water, tea, coffee, energy drinks, sodas, etc.
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Rate your digestion:
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Good
Fair
Poor
Are you a nose or mouth breather?
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Nose
Mouth
Unsure
If mouth breather, why?
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Asthma?
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Yes
No
Unsure
Blood pressure?
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Normal
High
Low
Unsure
If blood pressure abnormal, is it controlled with medication and type?
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History of heart disease? Please elaborate:
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History of anxiety or depression medication and how long?
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Current perceived stress level:
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Low
Moderate
High
Quality of sleep?
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Good
Fair
Poor
On average, how many hours of sleep do you get each night and the quality of rest you receive from it?
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Sitting at a desk or driving:
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8+ hours per day
4-8 hours per day
1-3 hours per day
Rarely
Standing
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8+ hours per day
4-8 hours per day
1-3 hours per day
Rarely
Carry heavy weight:
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Often
Sometimes
Rarely
Travel by plane:
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Often
Sometimes
Rarely
Please list all current medication and reason:
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Please list current exercises and physical activities:
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Please list team or competitive sports:
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Please list prior and/or current injuries or health conditions and explain:
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MOST IMPORTANT Please list your goals for practice/lessons:
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When are the best days and times for you to meet?
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Any additional comments or concerns?
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RELEASE/WAVIER OF LIABILITY AND AGREEMENT
I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will listen to my body, adjust the posture and ask for support from the teacher. I will continue to breathe smoothly. Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I have been checked by my doctor and cleared to practice yoga prior to signing up for private lessons with Ricky Tran. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Ricky Tran, their heirs, successors or assigns. I agree to the above policies and pricing for private yoga lessons with Ricky Tran
*
I agree. (Please make sure the form is properly submitted. If required fields are not filled out, the form will not send.)
Submit
Home
Bio
Testimonials
My lineage
Gallery
Media
Blog
Practice
New Students
Privates
>
Questionnaire
Returning Student Questionnaire
Unite.Live
Addison Circle Yoga
Learn
Suggested Reading
My Talks
>
Dharma Questions
Hatha Questions
Meditation Questions
Patanjali
4 Attitudes
Quotes
Chants
Bandhas
3 Gunas
77 Surprising Health Benefits of Yoga
My Father's Yoga by Desikachar
Yoga Makaranda
Bhagavad Gita
Ramaswami Chants
Booking
Host Studios
My Partners