Digital Patient Intake Form

Yoga Inspired Wellness LLC is dedicated to the promotion of personal growth, wellbeing, and the prevention of chronic illness and injury whenever possible. Yoga Inspired Wellness utilizes the time- tested techniques, principles and practices of yoga to support and facilitate natural mechanisms of healing, improved functionality, and increased self-awareness.

I have found my life’s passion in teaching yoga and helping others through yoga therapy. I received my 200 hour registered yoga teaching certificate (RYT) in 2017. Since then I have continually educated myself in the realm of all things yoga! I furthered my education by getting certified in chair yoga, trauma sensitive yoga, reiki, and numerous muscular-skeletal workshops. My 300 hour RYT certification was attained in 2019. Yoga Therapy was the next step! It has brought all my training into one amazing place where I can help people on multiple levels. This certification is accredited by the International Association of Yoga Therapists (IYAT) also in Yoga Therapist Experience. I look forward to helping you reach your specific health goals and to live your best life.

The yoga therapy session will be carried out by Kim Wedel who has achieved advanced level training from Spanda® Yoga Movement Therapist certification. I am certified by the International Association of Yoga Therapists, the standard of professional yoga therapists worldwide. Yoga therapist training, while including some yoga teaching methods, is not a yoga teacher training but a professional level therapist training using the techniques and methods of yoga science and philosophy. Your case adheres to all HIPPA standards and is confidential. In the case of needing to share your information with a licensed care provider for your best interest, you will be notified. I am obligated to report any suspicions of harm that may be inflicted upon you by others or yourself.

Fee and Billing

All fees are stated on the Yoga Inspired Wellness website, Yogainspiredwellness.com. All fees will be paid on the day the services are provided. Each session or bundled sessions are agreed upon by both parties. In the case of ending the contract, either the client or Yoga Inspired Wellness has the right to terminate the agreement if it is in the best interest of the client. All fees due or fees needed to be refunded will take place within 10 days of cancellation.

There is no charge if appointments are cancelled 24 hours in advance. Cancellations within 24 hours of the scheduled time will be charged a $50 cancellation fee.

I voluntarily consent to engage in Yoga therapy and participate at my own level of comfort, knowing I can decide to discontinue at any time. I understand that Yoga therapeutic methods are based on holistic principles and practices of Yoga, its science and philosophy, and western scientific data and are not, as yet, considered standard treatments in mainstream medicine.

During Yoga therapy sessions, I am aware I will engage in the activities designed for my concern. I agree to take responsibility by being mindful of what I can and cannot do and to inform my yoga therapist of limitations, symptoms, pain, discomfort, or other concerns that occur or change at any point. I understand that yoga involves both cognitive and physical elements and there is inherent risk when undertaking physical activity.

I realize Yoga therapy is designed to benefit my concern, but that success is not guaranteed. I acknowledge I must take an active role in performing the recommendations given for them to be affective.

I am aware that my Yoga therapist is not a licensed physician, and that Yoga therapy is complementary to licensed healing arts, and its practices are not currently licensed.

I understand that my Yoga therapist is certified and accredited by IAYT (International Association of Yoga Therapists) which is the highest level of yoga expertise for therapeutic yoga practice acknowledged worldwide.

I acknowledge that it is my responsibility to consult with my physician and obtain his or her consent prior to beginning yoga therapy. I also understand I have been advised to consult a physician for any health problems if I have not done so. I recognize it is my responsibility to ascertain that there is no medical reason preventing me from any specific practice. I realize that touching, guiding movement, or positioning my body may be necessary and I expressly consent to such physical contact. If I do not wish to be touched, I will notify the therapist, so a joint decision can be made about continuing the practice with this limitation.