Retreat Intake

About
SRY
Ayurveda
Māyurveda
Work with Me
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Welcome! This form helps me serve individuals in group programs and personalize my offerings for the people present in the room with me. This is the opposite of a blind webinar or distance program or huge group event. My small group programs are a group of individuals and our direct connection deepens my teachings and your results.

If you are an ongoing student or client, this form is optional!

Immersion Intake Form for Kaya

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Please leave a cell phone if possible, in the case of cancellation or schedule changes.

Main aspects of this program that are appealing to you. And any main issues - body, mind or spirit that you hope to address with this program? *

Do you have experience with spinal release forms of yoga - SRY, Svaroopa, Svarupa, Contemplative Practice, Core Opening,, etc, and if so, please describe. *

Describe any extensive experience with other forms of yoga or physical practice, athleticism or spiritual practice *

Check all that apply *

High Blood Pressure (even if treated by medication) Pain that prevents me from "doing a day" without rest Pregnant Post partum Low back pain Neck / Shoulder pain Headaches Anxiety Depression Insomnia Hyperactivity Low Motivation Spinal disc problems PTSD Burnt out / depleted Exhausted Overthinking Anxiety Overstrategizing Other None of the above

Feel free to share and describe any major life changes or difficulties that may be contributing to physical or mental pain. *

OPTIONAL: Please describe your daily sleep routines {waking and sleeping times} and quality of sleep as well as how you feel when you wake up in the morning. *

OPTIONAL: Please describe your average MEAL TIMES and typical foods you eat? Also include snacks. *

What limitations might prevent you from getting that change, growth, knowledge? (financial, time restraints, relationships, etc) *

What in your life does support you in your healing and transformation process or yoga practice? (Supportive partner, family, community, lots of time, enough money to dedicate to myself, etc.) *

Choose all that you believe will be helpful you and your goals? *

Self care and lifestyle practices Food / dietary recommendations Spiritual insight, viewpoints and practices Guided Relaxation Primary yoga poses for home practice Advanced Poses for expanded experience Chanting or Mantra Other {expand below}

Anything more you would like to add? Comment *

Expand on your interest in self care sleep or diet, if you want to *

Expand on your interest in home yoga practice, if you want to. *

How did you hear about Yoga with Kaya? *

Birthdate, Location, and if available exact time (or if you do not want to share, give your age) *

Submit

Kaya is the founder of SRY™ which is based in the full spectrum of the Vedic yoga tradition. She has been teaching therapeutic restorative yoga therapy since 2001. Kaya's work is healing, transformative, deeply rejuvenating and empowers her student and clients with wisdom and inner experience. Her trained in the full spectrum of the Vedic Tradition includes Yoga, Yoga Therapy, Prenatal Yoga, Ayurveda, Women's Health, Eastern Anatomy, Sanskrit, Vedic Astrology and Vedanta Philosophy. She collaborates with her husband Michael Manzella, a Vedic Astrologer, to serve yoga students and teachers who are inclined toward depth of inner experience and knowledge. MORE ON KAYA

About
SRY
Ayurveda
Māyurveda
Work with Me
Audio
Contact
- Resources