Name *

First Name

Last Name

How did you hear about us? *

Facebook/Instagram

From a friend or current member

Google

I walked by

Other

How long do you realistically think it will take to achieve these goals?

30 days

1-3 months

3-6 months

6-12 months

12+ months

How often would you like to come to Yoga Bliss to work on your wellness goals?

1 day per week

2 days per week

3-5 days per week

As much as possible

Only 1-2 times per month or less

Have not decided yet

What is the best time of day for you to attend classes? Are you a(n):

Early Bird (6am)

Mid Morning Mover (9-11am)

Lunchtime Lover (12 noon)

Afternoon Aficionado (4pm)

Early Evening Enthusiast (5:15pm)

Night Owl (8pm)

Weekend Warrior (Sat/Sun)