Along with yoga classes, I recommend various products and services. Complete the free assessment below for a custom solution.

Wellness Assessment

Please fill out the form below for your free initial consultation.
  • How many hours of sleep do you get in a typical night?
  • How many 8oz glasses of water do you drink a day on average?
  • Check the beverages you have on a daily basis.
  • How would you rate your energy level?
  • Do you exercise to stay active? If so, what types of exercise do you do?
  • How many hours a week do you consider yourself physical active (include exercise and other activity)
  • Please check the option that best describes the activity level of your job.
  • Do you have any physical restrictions or limitations that affect your ability to stay active? If so, please describe below:
  • Fow would you rate your stress level?
  • What are the sources of your stress?
  • How would you describe your diet? Select the option that is most applicable.
  • Do you wish to make changes to your diet? If so, why?
  • List any allergies below.
  • Do you have any health issues? If so, please describe below:
  • Please list anything else that is necessary to evaluate your current state of wellness.
  • I, the undersigned, understand that this consultation is not a substitute for medical attention, examination, diagnosis or treatment and may not recommended and or considered safe under certain medical conditions. I should consult a physician prior to beginning any wellness program. I recognize that it is my responsibility to notify Balance 2 Heal of pregnancy, any serious illness, and/or injury before proceeding. I affirm that I alone am responsible to decide on my wellness. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Balance 2 Heal or Eliza Alys Young. Those under 18 years of age must have this form signed by a parent or guardian.

    I confirm that I have read and agree to the Terms & Conditions.

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