Client Feedback Form Full Name *Email Address *Yoga programs you enrolled yourself or your child: *Fitness YogaSpecialized YogaKids YogaTeens YogaPrenatal YogaPostnatal YogaSpecialized Yoga for KidsNutrition and Lifestyle ConsultationHow did the Prenatal/Postnatal program impact you?Addressed my pregnancy problems: *YesNoHad little or no issues during my pregnancy: *YesYes - In progressNoHad no major concerns during delivery: *YesNoHad to go through CS: *YesNoReason for CS:Gave birth to a healthy baby: *YesNoBaby has grown healthily since birth: *YesNoRaised my awareness (nutrition, sleep, lifestyle, baby’s growth): *YesNoHow did the Specialized Yoga program impact you?What is/was the focus of your Specialized Yoga program? *Stress ManagementMental Health (Anxiety, depression, panic attack)Women’s Reproductive & Hormonal HealthMen’s Reproductive HealthRespiratory HealthDigestive HealthObesity and Weight LossCardiovascular HealthCancerAuto-immune diseaseNeurological IllnessOtherIf Other, please specify: *Addressed my Reproductive health concerns: *YesNoRegained hormonal balance: *YesNoRegained reproductive and physical health: *YesNoRegained mental health: *YesNoRaised my awareness (nutrition, breathing, relaxation, concentration, sleep, lifestyle): *YesNoWhat is/was the focus of your Specialized Yoga for Kids program? *ADHDDyslexiaSpeechMotorEpilepsyPhysical DisabilityMental DisabilityOtherHow did the Specialized Yoga for Kids program impact your child?Better concentration: *YesNoBetter memory: *YesNoHigher confidence level: *YesNoPhysical strength and flexibility: *YesNoHigher academic performance at school: *YesNoBetter social behaviour: *YesNoAddressed my child's concerns: *YesNoHow were your behaviour and actions before joining the Nutrition and Lifestyle coaching program?Eating well before: *Not GoodSomewhat GoodGoodSleep before: *Not GoodSomewhat GoodGoodDaily practice (Postures, Breathing, Relaxation) before: *Not GoodSomewhat GoodGoodQuality of relationships before: *Not GoodSomewhat GoodGoodProductivity at work before: *Not GoodSomewhat GoodGoodHow were your behaviour and actions after completing the Nutrition and Lifestyle coaching program?Eating well after: *Not GoodSomewhat GoodGoodSleep after: *Not GoodSomewhat GoodGoodDaily practice (Postures, Breathing, Relaxation) after: *Not GoodSomewhat GoodGoodQuality of relationships after: *Not GoodSomewhat GoodGoodProductivity at work after: *Not GoodSomewhat GoodGoodWhat was the state of your health before joining the program?Physical Health before: *Not goodGoodVery GoodMental Health before: *Not goodGoodVery GoodWhat is the state of your health now (after joining or completing the program)?Physical Health now: *Still not goodBetterBack to healthMental Health now: *Still not goodBetterBack to healthWhat are your major health concerns today?Physical concern:Mental concern:Emotional concern:Are you happy with the results of the program? *Not happySomewhat happyHappyVery happyWhy did you stop the program?Regained physical healthRegained mental healthPersonal commitmentsProgram did not address my concernsWould you refer us to your friends and family? *YesNoCan you please share your thoughts and comments so that we may serve you better? *We thank you for taking the time to help us out by filling out the above form. Your personal data is confidential and will not be shared without your prior consent (refer to the Privacy Policy on our website).Submit
