Contact Us Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *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?EmailSubmit