center for integrative yoga therapeutics

If you would like an Integrative Yoga Therapeutics session, please fill out the form below. A therapist will contact you within 48 hrs to answer your questions and/or set up an initial consultation. Thank you for your interest in the Center for Integrative Yoga Therapeutics!

Please note that the information you provide below will be maintained as confidential by the Center, to the extent recognized by law.

  • First Name:*
  • Last Name:*
  • Email:*
  • Best times to reach you:*
    a.m.
    p.m.
  • Address:*
  • Age:*
  • Therapeutic Interests (select all that apply):*
    Alignment and the Physical Practice
    Arthritis
    Spinal anomalies (e.g. kyphosis, lordosis, scoliosis)
    Hypermobility/Joint Laxity
    Pain Disorders
    Anxiety
    Insomnia
    Depression
    Stress Management
    Injury Prevention and Rehabilitation
    Performance Development/ Performance Enhancement
    Fertility
    Pregnancy
    Addictions
    PTSD
    Auto-Immune Disorders
    Other
  • Previous yoga experience:*
  • Current physical limitations or injuries:*
  • Goals/Expectations:*
  • Preferred yoga therapist (if applicable):*
  • Please note that some of our yoga therapists may currently have waiting lists.
  • Preferred location for private sessions:*
  • Times you are available for sessions:*
  • Any other information you would like to share:
  • Where did you hear about CIYT? (select all that apply):*
    From a friend/colleague (list name if you wish)
    From my practitioner (please list name):
    Teacher Recommendation: (Name of teacher(optional):
    Yoga Journal
    International Association of Yoga Therapists (IAYT)
    Kripalu
    Yoga Alliance
    Google
    Other
  • Please add me to the Elemental Yoga e-newsletter:
    Yes
    No

* = required information

inhale | exhale