IMPORTANT: Please Complete the Below Two Forms Prior To Your Session

These forms help me best prepare for your session. Thank you!

Please Read: Ethical Commitment Statement


I, Jocelyne Frank, am a Certified Yoga Therapist with the International Association of Yoga Therapists (C-IAYT). 

I will make the following ethical commitment to you:

  • Acknowledge the limitations of my skills and scope of practice and where appropriate, refer students to seek alternative instruction, advice, treatment or direction.

  • Create and maintain a safe, clean and comfortable environment for the practice of yoga.

  • Encourage diversity by respecting all students regardless of age, physical limitations, race, creed, gender, ethnicity, religion or sexual orientation.

  • Respect the rights, dignity and privacy of all students.

  • Keep any information you share in person or in writing confidential and secure.

  • Adhere to the traditional yoga principles as written in the yamas and niyamas.

  • Conduct myself in a professional and conscientious manner. This includes, but is not limited to, ensuring that I live up to any commitments I make to my students or to the public, and ensuring that my practices and behavior conform to the representations I make about myself in holding myself out as a yoga practitioner who adheres to certain precepts.


…Please feel comfortable to ask me any questions about my training. I also appreciate any feedback you may willing to share with me so that my learning can continue.

Confidentiality Note
Answering the questions in this form will assist me to customize the program for you and alert me to any precautions or sensitivities that may impact your practice and well-being. If there are any questions that do not apply to you please mark them with N/A . I commit to keeping your responses confidential and secure. I understand that many of these questions are very personal and fully respect if you choose not to share information that is prompted in the questions below.

Form #1: Acknowledgement and Wavier


There are 2 forms. Please ensure that after you submit Form #1, you keep scrolling down the page and complete Form #2 as well.


I (‘insert your name in the box below’) acknowledge that Jocelyne Frank, who I will be working with, has informed me that Yoga with a therapeutic approach is not a medical procedure; and that they will not be providing a diagnosis of any medical problems or concerns which I have.

I understand that Yoga with a Therapeutic approach is an integrative practices intended to facilitate self-awareness, integration and balance to my well-being. I also understand that I am solely responsible for my health, safety and well-being. I agree to inform the yoga instructor of any activity or movement which I cannot perform safely, and that I will not perform any activity or movement, which I feel, is likely to cause me to injure myself.

I agree to hold Jocelyne Frank harmless from any and all responsibility for any injury, which I may sustain during or as a result of my Yoga therapy informed private one on one session.

Form #2: Personal History Form