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Share with me: how this journey started for you?

Your diagnosis (when were you diagnosed, what was your diagnosis):

Your treatment (surgery, chemo, radiation):

Your medical teams (what other medical professionals are you working with currently, e.g. doctors, surgeons, radiologists, physical therapists):

How often do you receive treatment and when was your last (whether chemo, radiation or PT):

Are you taking any medication? If yes, what have you been prescribed:

What is your quality of sleep (do you feel rested, do you have difficulty falling asleep/staying asleep):

Has your treating physician placed you on any restrictions? If yes, what are they:

Where is your physical pain and what does it feel like (site specific, overall body, joint aches):

Where is your emotional pain and what does it feel like (sad, depressed, alone, roller-coaster ride):

Please rate on a scale of 1-10 your level of Anxiety/Stress (Based on your self-assessment):

Please rate on a scale of 1-10 your level of Strength (Based on your self-assessment) :

Please rate on a scale of 1-10 your level of Balance (Based on your self-assessment):

Please rate on a scale of 1-10 your level of Flexibility (Based on your self-assessment):

What do you do now for self-care:

What do you enjoy most (hobbies, activities):

Do you have a support network (family, friends):

How familiar are you with Yoga:

Is there anything additional you would like to share to better enable me to design a yoga experience tailored for your unique, individual Self?

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