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Client information, terms, and agreement

Please fill out this form, it is mandatory and essential in the process. Thank you!

First Name

Email Address

Permanent Address

Last Name

Date of Birth

Phone

Do you have any medical conditions/medications I should know about?

Which Program/ class are you choosing?

What is your hope for the outcome of this program/class?

Payment options

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Your Signature (use mouse to sign)

Today's Date

Thank you for filling out this form, I will be emailing you your invoice within 24 hours!

(please check your junk/spam folders as well.)

Contact: Ashley@TheMigraineYogini.com

Disclaimer: The Migraine Yoga Program®, BreathCoaching, The Migraine Yogini® and instructors are not medical doctors, They do not diagnose, cure, etc. any disease or illness. If you have an existing medical condition or injury, make sure your doctor approves of yoga and or breath coaching as a self-care practice. Your health is your responsibility, please take care.

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