Thank you for booking with Dr. Steffany Moonaz

All coaching and yoga therapy should begin with an intake process. Please complete the intake form in full and send it at least one week prior to this first appointment. You can complete the form by clicking on the button below and then emailing the completed form to info@arthritis.yoga or electronically below. In this session, you will discuss the therapeutic relationship along with your goals. Dr. Moonaz will ask some follow-up questions and will conduct a physical and breath assessment for yoga therapy clients. You will have the opportunity to share anything additional and to ask any questions you might have. You will also walk away with a few tools or practices that you can start using immediately in advance of your next session.

After you complete the form, please email to:
info@arthritis.yoga

Get The Form Here

Preferred First and Last Name

First Name

Last Name

Preferred Pronouns

Preferred Email

Preferred Phone Number

(###)

###

####

Where Are You Located?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Who lives in your household?

People and Pets

Annamayakosha- Physical Health and History

Please list any relevant medial history. Years, Events, Treatments, and Outcomes

Please list any current diagnosed conditions and treatments.

Conditions, years diagnosed, current treatment, current status.

Do you experience any chronic pain?

If so, list location, frequency, intensity, duration, and description.

Pranamayakosha- Breath and Energy

What time of day do you have the most energy?

How do you describe the quality of your sleep?

Do you experience fatigue?

Please describe the impact, frequency, and what you do to manage it.

Do you have any breathing challenges not mentioned above?

How would you describe your breathing?

Menomayakosha- Mental Health and History

Please describe any relevant mental health history.

Please list any current mental health diagnoses and treatments

Conditions, Year Diagnosed, Prescription, OTC, Behavioral, Current Treatments, Current Status, Etc.

Vijnanamayakosha (Wisdom and Intellect)

What are the major sources of intellectual stimulation and engagement in your life now?

What are you in the process of learning and/or teaching others?

What would you like to learn and/or teach?

Anandamayakosha (Connection and Meaning/Purpose)

Do you have a religious/spiritual orientation?

What connection is important for your life and health?

Nature, family, pets, volunteering, etc.

Do you feel connected in meaningful ways?

Do you feel that you know why you are here?

Alive on earth.

What should I know about your belief system or worldview?

Yoga Histroy

Do you have any experience with yoga/meditation?

If you currently have a yoga practice, please describe it.

What is your primary motivation for seeking yoga?

Anything else you feel I should know?

Thank you for booking with Dr. Steffany Moonaz

Yoga for Arthritis