🧘‍♀️Yin Yoga Healing & Transformation Case Study

Name

Email Address

Date of Birth (DD/MM/YYYY)

Age

Biological Sex

How would you describe your current level of physical activity?

On average, how many hours of sleep do you get per day (include naps)?

How would you rate your overall stress levels?

Do you currently engage in yoga, meditation, or mindfulness practices?

Yes, regularly Occasionaly Rarely Not currently

If yes, please describe your current practice – style, frequency, etc. :

What are your main goals or intentions for participating in this Yin Yoga study? E.g. healing an injury, reducing stress, increasing flexibility, emotional regulation, personal growth

Do you have any current or past injuries or surgeries?

Yes No

If yes, please describe the injury or surgery (location, date, recovery status, etc.):

Do you have any chronic conditions or ongoing health concerns?
(e.g. arthritis, back pain, autoimmune conditions, fatigue, hormonal imbalance)

Are you currently taking any medications that may affect your physical or emotional state during yoga practice?

Are you under the care of a healthcare professional (doctor, physiotherapist, psychologist, etc.)?

Do you have any heart conditions, high blood pressure, or circulation issues?

Yes No

Are you pregnant or recently postpartum?

Yes No

Are there any movements, postures, or areas of your body that feel restricted, painful, or need to be avoided?

How would you describe your current energy levels throughout the day?

Consistently high Generally steady Often low / fatigued Fluctuates significantly

What are your main sources of stress or emotional strain in daily life?

How do you currently relax, unwind, or reconnect with yourself?

What do you hope to experience, learn, or heal through Yin Yoga?

Please read and confirm each statement:
→ Checkboxes (must tick all to submit)

I understand that this case study involves physical and mindfulness-based practices, and I am participating voluntarily. I agree to inform the facilitator of any discomfort, injury, or concern that arises during the study. I understand that Yin Yoga is not a replacement for medical care, and I am responsible for my own health and safety during participation. I consent to my anonymized data being used for study purposes and possible publication of collective results.

Would you be open to sharing a short written reflection or testimonial at the end of the study?

Yes No Maybe

Electronic Signature (type your full name):

Date (DD/MM/YYYY)

Preferred way to hear from me

Phone Number

✨ That’s it! Send it over and I’ll be in touch soon.

Yin Yoga with Hong

🧘‍♀️Yin Yoga Healing & Transformation Case Study

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