Lisa Haake Therapies - New Patient Forms

When you make an appointment please arrive about 15 minutes early to fill out any necessary forms. If you would prefer, you can download the paperwork packet, fill out the information and bring the forms to your appointment if that is more convenient.

Registration
Form

Please print out the Client Registration Form and fill it out before your first appointment.

Contract /

Fee Agreement

This contract includes information about fees, cancellations, insurance and the process for ending therapy.

Orientation

Information

Please print out the Orientation Information to review and complete before your first appointment.

Yoga Therapy Disclosure
and Release Form

Please print out and sign this form before your first yoga appointment.

Insurance

Information

Please print out the Insurance Information and Release Form and fill it out before your first appointment.

Yoga Therapy
Intake Form

Please print out and sign this form before your first yoga appointment.

1210 E. Main St. 

Urbana, IL 61801

lisa.haake@gmail.com

 

Tel: (217) 721-2617

Mon: 1pm - 8pm

Tues: 11am - 5pm

Wed: 11am - 5pm

Thurs: 1pm - 8pm

Fri: 1pm - 5pm

Click the icon to review and download any forms you may need before your appointment.

1210 E. Main St. 

Urbana, IL 61801

lisa.haake@gmail.com

 

Tel: (217) 721-2617

  • Lisa Haake Therapies on Facebook
  • Pure Being on Instagram

Mon: 1pm - 8pm

Tues: 11am - 5pm

Wed: 11am - 5pm

Thurs: 1pm - 8pm

Fri: 1pm - 5pm