Customized Yoga - Yogi Brian - yogic breathing, yogic body sculpting

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Please accept a Free 45-MINUTE Private Yoga Session with Brian at his studio.

Your Free Introductory Session includes . . .

Customized Yoga
CORE Conditioning
Rehabilitative and Therapeutic Exercise
Total Integrated Strength Training
Yogic Body Sculpting
Expert Guided Meditation
Breathing Instruction
Advanced Nutritional Programming

To schedule your Free Private Yoga Training Session or just introduce yourself to Brian as a future class student, please complete and send the Personal Profile form below . . .

Personal Profile Form
You are about to change your life forever. The information you provide in your Personal Profile form will be kept in the strictest confidence. Please be specific.

An asterisk mark * indicates a required information field.

First Name*

Last Name*

Date of Birth

Gender*
Male Female
Pregnant Female months
Address 1*

Address 2

City*

State*

Zip Code*

Home Telephone*

Cellular Telephone

Work Telephone

work ext.
Email Address*

Website Address

How did you learn about Brian Buturla?
I am interested in* (You may select several with CONTROL-CLICK or APPLE KEY-CLICK on the Mac)
Has a physician ever advised you against exercise?*		NO YES, please explain:
Please explain any health problems you have, medications you take, including dosages and therapies you are undergoing.
Do you have any injuries?*		NO YES, please explain:
How do you rate your over-all health?
Consumption of: Alcohol times/week Caffeine times/week		Nicotine/Tobacco times/week Other times/week
Previous yoga experience?		NO YES, please explain:
Do you have any children?		NO YES,
How would you describe yourself to someone who has never met you?
Explain a typical day in your life?
Can you pinpoint what stresses you?
How do you relax?
What motivates you?
What are you passionate about?
What are your strengths?
What are your weaknesses?
What are your greatest accomplishments?
What type of music do you like?
Have you ever worked privately with a yoga teacher before?		NO YES, Name of Teacher
In what state?
For how long?
What do you want to accomplish with Brian's help?
Are you cross training for a specific event, occasion or sport?		NO YES, please explain:

Describe your current exercise program

Days per week of yoga

Type of yoga

Days per week of cardiovascular activity

Type of cardiovascular activity

Days per week of weight training

What are your long-range personal fitness and health goals?

I want to meet privately with Brian

What are the most convenient days and times for you to meet with Brian?
(You may select several with CONTROL-CLICK or APPLE KEY-CLICK on the Mac)

Additional information I want Brian to know

I would like Brian to get to know. . .

First Name

Last Name

Address

City

State

Zip Code

Telephone

Email

Please leave this box empty:

Thank you for taking the time to tell me about yourself. The information you have provided will help me personalize your next yoga experience.


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