Yogi Brian - Yoga Teacher
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Yoga Class
Introduce yourself to Yogi Brian Today.

Your Introductory Sessions includes . . .
  • Customized Yoga
  • Yoga CORE Conditioning
  • Rehabilitative and Therapeutic Yogic Exercise
  • Total Integrated Yoga Asana and Yogic Strength Training
  • Yogic Body Sculpting
  • Expert Guided Meditation
  • Breathing Instruction
  • Advanced Yogic Nutritional Programming
To introduce yourself to Yogi Brian please complete and send the Personal Profile form below . . .



Personal Profile Form
You are about to change your life forever. The information you provide in your Personal Profile form will be kept in the strictest confidence. Please be specific.

An asterisk mark * indicates a required information field.

First Name*

Last Name*

Date of Birth



Gender*
Male Female
Pregnant Female months
Address 1*

Address 2

City*

 
State*

Zip Code*

Home Telephone*

Cellular Telephone

Work Telephone

work ext.
Email Address*

Website Address





How did you learn about Yogi Brian?
 
I am interested in*
(You may select several with CONTROL-CLICK or COMMAND KEY-CLICK on the Mac)
 
Has a physician ever advised you against exercise?*
  NO YES, please explain:

Please explain any health problems you have, medications you take, including dosages and therapies you are undergoing.
 
Do you have any injuries?*
  NO YES, please explain:

How do you rate your over-all health?
 
Consumption of:

Alcohol times/week
Caffeine times/week

  Nicotine/Tobacco times/week
Other times/week

Previous Yoga experience?
  NO YES, please explain:

Do you have any children?
  NO YES,
How would you describe yourself to someone who has never met you?
 
Explain a typical day in your life?
 
Can you pinpoint what stresses you?
 
How do you relax?
 
What motivates you?
 
What are you passionate about?
 
What are your strengths?
 
What are your weaknesses?
 
What are your greatest accomplishments?
 
What type of music do you like?
 
Have you ever worked privately with a Yoga Teacher before?
  NO YES, Name of Teacher

In what state?
 
For how long?
 
What do you want to accomplish with Brian's help?
 
Are you cross training for a specific event, occasion or sport?
  NO YES, please explain:





Describe your current exercise program

Days per week of Yoga
 
Type of Yoga
 
Days per week of cardiovascular activity
 
Type of cardiovascular activity
 
Days per week of weight training
 
What are your long-range personal fitness and health goals?
 
I want to meet privately with Brian
 
What are the most convenient days and times for you to meet with Brian?
(You may select several with CONTROL-CLICK or COMMAND KEY-CLICK on the Mac)
 
Additional information I want Brian to know
 




I would like to introduce Yogi Brian to:

First Name

Last Name

Address


  City

State

Zip Code

Telephone

Email


Please leave this box empty:

Thank you for taking the time to tell me about yourself. The information you have provided will help me personalize your yoga experience here at my studio.

Talk to Brian! 203.838.9644 SITE MAPDIRECTIONS

Yogi Brian Buturla
8 Parkhill Avenue, Norwalk CT 06851
Email: Brian@YogiBrian.com
203.838.9644
Copyright 2012 Yogi Brian Buturla. All text, logos & photographs reserved & protected. No content or imagery can be used or duplicated without the expressed written consent of Yogi Brian Buturla.